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Full text of "The health of missionary families in China : a statistical study"

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tihr<ivy of t:he theological ^tminary 

PRINCETON . NEW JERSEY 

FROM THE LIBRARY OF 
ROBERT ELLIOTT SPEER 



BV 3415 .L45 

Lennox, William Gordon, 188 



— The health of missionary 




rOTAL HOMbtR. DCATHJ PER looo LIVIMO BIRTHS 



7B AND 74 TO 101' rO I'ZU TD ISI TO 1/4 TO 20I AND 
BELON too 125 ISO I7B 200 OVER. 




Frontispiece. Mortality of missionary children by provinces. (Illustrating 
Table 25.) The more heavily shaded the province, the higher is its 
mortality rate. The figui-es under the name of the province indicate the 
number of children dead (of all ages) per 1,000 living births. The heavy 
lines mark the division into North, Central, and South China used in 
this study. Honan is included in Central China. Absence of boundary 
lines between provinces means that in the tabulations these provinces are 
grouped together. . 



THE HEALTH OF MISSIONARY 
FAMILIES IN CHINA 

A Statistical Study 



/ By 

Wm. G. Lennox, M. D. 



Department of Economics 

University of Denver 



DENVER, COLO. 

U.S.A. 



o^ 



Acknowledgment 

The writer wishes to acknowledge the assistance given by 
the many missionaries who spent much time and thought in 
giving of their experiences and advice. Special thanks are 
due to Dr. H. S. Houghton, through whom the Peking Union 
Medical College made a contribution of Mex $300, toward the 
expenses of the study; to Rev. C. L. Boynton, editor of the 
China Missionary directory; to Professor G. A. Warfield, of 
the University of Denver, to various mission board officers 
who have manifested an interest in this study, and to the 
students, both Chinese and American, who have assisted in 
the task of tabulation. 



Contents 

PART I. The Health of the Childbeit 



P»!te 

Introduction 9 

The Value of Child Life to Missions 10 

What This Study Hopes to Do 10 

Method of Collecting Data 11 

General Facts Concerning Data 12 

The Number of Children 14 

Children per Marriage 14 

Childless Marriages 17 

Size of Families 18 

Ages and Years in China 20 

Masculinity 23 

Conditions Affecting Children 23 

Comparative Mortality 24 

Missionaries and Chinese 24 

Missionaries in China and Japan 25 

Infant Mortality 26 

Mortality in Early Childhood 28 

Factors in Child Mortality 30 

Geographical Location 31 

Missionary Societies 33 

Societies in Relation to Location 37 

Size of Societies 40 

Nationality of Societies 40 

Birthplace of Parents 41 

Medical Training of Parents 43 

Ratio of Doctors to Mission Force 40 

Recent and Remote Periods 47 

Order of Birth 50 

Number of Children in Family 51 

Birthplace of Children 52 

Other Factors of Child Mortality 52 

Cause of Deaths by Groups of Diseases 54 

Geographical Location 54 

Missionary Societies 55 

Nationality of Societies 58 

Birthplace of Parents 59 

Medical Training of Parents 59 

Recent and Remote Periods 60 

Order of Birth 61 

Number of Children in Family 63 

3 



CoNTEN TS — Continued 

Page 

Causes of Deaths by Individual Diseases 64 

Deaths Outside China 69 

Morbidity Among Children 70 

Percentage of Mortality 75 

Major and Minor Infections 7G 

Geographical Location 77 

Missionary Societies 77 

Age at Time of Sickness 78 

Mortality Rate in Relation to Age 79 

General Health of Children 79 

Geographical Location 79 

Missionary Societies 80 

Miscarriages and Stillbirths 81 

Geographical Location 82 

Missionary Societies 84 

Causes of Miscarriages 84 

Conditions Other Than Health 86 



PART II. Health of Married Adults 

Introduction 87 

Facts Concerning Residence and Marriage 88 

Mortality Among Adults 91 

Morbidity Among Adults 91 

Geographical Location 92 

Period When Sicknesses Are Contracted 96 

Proportion Without Serious Sickness 97 

Past General Health 98 

Geographical Location 98 

Missionary Societies 99 

PART III. Some Factors in Prevention of Disease 

The Preventable Diseases 100 

Dysentery 100 

Typhoid Fever 101 

Smallpox 102 

Causes of Infection 105 

Methods of Disease Prevention 106 

The Responsible Agencies 110 

The Extravagance of Sickness 114 

Summary 115 

References 120 

4 



Tables and Chaets 

Tables are illustrated in whole or in part by the Figures whose numbers 

ARE indicated. 

Table Figure 

Nuiuber Number Page 

1 Percentage answering questionnaire by provinces 13 

2 Percentage answering questionnaire by societies 13 

3 Number of children born, now living and now dead, per family 

of missionaries, by years of marriage 14 

4 Size of families of faculty members of American universities. . 14 

5 Number of children per family for various groups in compari- 
son with missionary families 15 

6 Number of married years per living birth by groups of societies 15 

7 12 Number of children per family by societies 16, 35 

8 Number of children per family, and percentage of families 
without children, by groups of societies of various nations. ... 16 

9 Percentage of families with specified number of children born, 
by years of parents' marriage 18 

10 Size of families of American college teachers, of women col- 
lege graduates and of missionaries 18 

11 Percentage of families with specified number of children now 
living, by years of parents' marriage 19 

12 Percentage of families with specified number of children now 
dead, by years of parents' marriage 19 

13 Percentage of families with specified number of children dead, 
by societies 19 

14 Children — percentage of years in China, by provinces 20 

15 12 Number of years of life of children, and years spent in China, 

by societies 21 

16 Number of children alive, by age and province 22 

17 Relation of male to female births, by groups of provinces 23 

18 1 Mortality among children of missionaries and of lower class 

Chinese 24 

19 2 Mortality of missionary children in China and in Japan 25 

20 Percentage of infant deaths occurring by months, for United 
States and various classes of English society, and for mis- 
sionary children 26 

21 3 Infant mortality occurring by months for two classes of Eng- 

lish society, and for missionary children 27 

22 4-5 Mortality for the first ten years among missionary children 

and among children in America and England 28 

23 6 Child and infant mortality in city and country districts of 

England compared with those of missionary children 29 

24 7 Percentage of children dying, and percentage now living, at 

various ages 30 

25 8-9-10 Mortality of children by provinces, arranged by geographical 

Frontispiece SectlonS 31, 32, 33 

26 11-12 Mortality of children, by societies 34, 35 

27 Mortality of children in societies reporting between 20 and 

75 children 37 

28 Percentage of children living in sections of China, by societies. 37 

29 Mortality of children by societies, and by sections of China 39 

5 



Tables and Charts — Continued 

Table Figure 

Number Number Page 

30 13 Mortality of children with reference to size of missionary 

societies 40 

31 14 Mortality of children by nationality of societies 41 

32 15 Mortality of children, by birthplace of parents 41, 42 

33 16 Mortality of children, by medical training of parents 43 

34 17 Mortality of children by medical training of parents and by 

sections of China 44 

35 18 Mortality of children by medical training of parents and by 

groups of societies 45, 46 

36 Percentage of physicians to the total adult missionary force, 
by societies 47 

37 Mortality of children by length of time parents have been 
married 48 

38 19 Mortality among first and second born children by number of 

years parents have been married 49 

39 20 Mortality of children by order of birth 50 

40 21 Mortality of children by number of children in family 51 

41 22 Mortality of children by birthplace 52 

42 23 Mortality from various diseases by sections of China 54 

43 24 Mortality of children from various causes, by societies. .. .56, 57 

44 25 Mortality of children from various diseases by nationality of 

missionary societies 58 

45 Mortality of children from various causes by birthplace of 
parents 59 

46 26 Mortality of children from various causes by medical training 

of parents 59, 60 

47 27 Mortality of children from various causes by number of years 

parents have been married 60, 61 

48 28 Mortality of children from various causes by order of birth. 61, 62 

49 29 Mortality of children from various causes by number of chil- 

dren in family 63 

50 30 Causes of deaths of children, with age at time of death 64, 65 

51 31-32-33 Percentage of deaths occurring at specified ages, due to various 

causes, compared with United States and England 66-69 

52 Causes of deaths occurring outside of China 69 

53 34 Absolute number of cases of principal infections and number 

per 1,000 years of residence, by provinces 71, 72 

54 Number of principal infections by sections of China, and occur- 
ring outside of China 73 

55 35-36 Number of principal infections per 1,000 years of residence in 

China and occurring outside of China 74, 75 

56 37 Percentage of mortality for various diseases, by sections 76 

57 Number of infections of children, by provinces 77 

58 Number of infections of children, by societies 77 

59 Age of children at time of sickness 78 

60 Percentage of sicknesses resulting in death at various ages. ... 79 

61 41 Past general health of children, by provinces 80, 98 

62 Past general health of children, by societies 81 

63 Number and percentage of stillbirths and miscarriages, by 
provinces 82 

64 Number of miscarriages, by provinces 83 

65 Summary of miscarriages, by sections 83 

66 Number and percentage of stillbirths, by societies 84 

6 



Tables ajstd Charts — Continued 

Table Figure 

Aumber Number Page 

67 Causes of miscarriages which occurred in China 85 

68 Summary of principal causes of miscarriage occurring in and 
outside of China 86 

69 Average number of married years and proportion spent in 
China, by provinces 88 

70 Average number of years adults (now married) have been 
residents in China, by provinces 89 

71 Number of years adults (now married) have been residents 

In China, by provinces 89 

72 Number and years of married life and percentage of married 
life spent in China, by societies 90 

73 Incidence of principal infections among adults, by provinces. . . 92 

74 38-39 Number of sicknesses per 100 married missionaries, in order 

of frequency, by sections 93,95 

75 Causes of invaliding of 203 church missionary society mis- 
sionaries 95 

76 Married missionaries, number of years after arriving in China 
when sicknesses were contracted 96 

77 40 Percentage of husbands and wives who have not had any im- 

portant sickness while living in China 97 

78 41 Past general health of husband and wife, by provinces 98 

79 Past general health of husband and wife, by societies 99 

80 42 Sickness from typhoid fever among married missionaries and 

United States soldiers 101 

43 Money saving which would result from reduction of typhoid 
fever rate 102 

81 44 Mortality from smallpox among missionary families (adults 

and children) and among general population in England and 
the United States 103 

82 Cases of smallpox, with reference to previous vaccinations. .. .104 

83 Advice concerning health by missionaries 106 



Illusteations 

Pages Facint 

Groups of Missionary Children in Peking 86-87 



The Health of Missionary Families in China* 



A Statistical Study by the heads of the famihes in 

collaboration with Wm. G. Lennox, M. D., 

Peking Union Medical College 

Peking, China 



Part I— The Health of the Children 



INTRODUCTION 

Our first summer in China was one full of anxiety because 
of the protracted illness, with dysentery, of one of our chil- 
dren. The question, "How can we serve in Chma, and at the 
same time safeguard the life and health of the children en- 
trusted to us?" pressed for an answer. Realizing that the 
question is one which all missionary parents in China must 
ask, the writer decided to call these parents into consultation 
in order to get their experience, and to secure the basic facts 
necessary for a scientific study of the problem. 

Let it be said at the outset that this study is the work of 
the thirteen hundred heads of families who participated in it. 
The writer has acted merely as a human sorting and tabu- 
lating machine. No one could study these personal accounts 
for two years without gaining deep respect and admiration 
for the devotion and courage of the isolated and disease- 
beleaguered missionaries, who count not their lives dear. 

"When our child was desperately sick," writes one 
mother, "and there was no doctor within many days' journey, 
following James 5:14, we anointed him with oil in the name 
of the Lord, and prayed to God for his recovery." 

No one, let it be said also, could read such accounts of the 
extremities in which parents have been placed without gain- 
ing the strong desire to aid in stopping the preventable, and 
therefore useless, portion of the sacrifices of life, and of 
spirit. 

* Presented as a thesis for M. A. degree, University of Denver. 

9 



10 The Health of Missionary Families in China 
THE VALUE OF CHILD LIFE TO MISSIONS 

Why is the health of missionary children of vital impor- 
tance to the missionary cause ? 

1. In the missionary army, unlike other armies, wives 
and children are an integral part of the force. How many 
missionaries have been forced to the rear because members 
of the family could not live in the front line trenches ? How 
many more have had their enthusiasm for work or the work 
itself undermined by the eating anxiety over the sickness or 
death of children? 

2. The children of missionaries, because of their inher- 
itance, and their inborn knowledge of the country, form the 
most promising of any body of prospective missionary 
recruits. 

3. The existence of an unnecessarily high death rate 
among children would be a cause of reproach to the mission- 
ary body and would deter the enlistment of conscientious 
married volunteers. 

4. It is a well-recognized axiom that in any community, 
infant and child mortality rates furnish an index to the health 
of that community. Where infant death rates are high, the 
mortality of adults is also above normal. 

WHAT THIS STUDY HOPES TO DO 

Modern measures for the promotion of health rest on the 
foundation of vital statistics. The first step in any intelligent 
effort to improve the health of a community is the collection 
and digestion of the facts concerning the present health of 
that community. Just so, we can not answer the question of 
*'How conserve the life of our children?" until certain other 
questions are answered, e.g. : 

*'Do children in China suffer more than their fellows in the 
homeland ? " 

*'What diseases are most to be feared — for the various sec- 
tions of China, and for various divisions of the mission- 
ary body?" 

**At what ages is there greatest danger?" 

''What harm, if any, are the clearly preventable diseases 
doing?" 

''What advice can those who have been long years in China 
give to those who are arriving?" 



The Health of the Children 11 

The answers to these and similar questions will clear the 
ground for future intelligent action looking toward the better 
health of the missionary children. Such a study as this is 
only preparatory. If it does not result in action by mission- 
ary boards and by missionaries, the time given to it by the 
small army of contributors will be lost. 

It should be said that the collection of this data was un- 
dertaken by the writer on his own responsibility. The results 
of the study were presented to the conference of the China 
Medical Missionary Association and received the approval of 
its members. It should be possible to make such a study as 
this from mission board records, but most boards have not as 
yet seen the economy of money and life which would result 
through a modem system of vital bookkeeping, and health 
information which they possess is buried in the files. If the 
information were collected, it would have little to say con- 
cerning the children. 

Though it is evident that such a study should be in the 
hands of mission boards, there is a certain advantage of a 
personal, unofficial collection of data. Many missionaries 
wrote more frankly than they would to a non-medical com- 
mittee. The material is for all of China and is more uniform 
than if gathered by separate societies. In the presentation of 
material the writer takes the view that the Christian forces 
in China should present a united front and a united program; 
and that the important facts concerning health conditions 
should be known by all, so that all may join to build up the 
weak places. 



METHOD OF COLLECTING DATA 

In the fall of 1918 a letter with question blank and return 
envelope was sent to all the married missionaries listed in the 
missionary directory. Several circumstances have delayed 
completion and have prevented one hundred per cent, accu- 
racy of tabulation: (1) Replies continued to come in for more 
than a year after the questions were sent out. This meant 
doing over a number of completed tables. Some of the less 
important ones were not revised. (2) Many blanks were 
incompletely filled in, figures were inconsistent, or handwrit- 
ing was open to various interpretations, making, accurate tab- 
ulation difficult. (3) The work was done without the aid of 
special mechanical tabulating appliances or of trained clerical 
assistance. Most of the larger tabulations have been repeated 



12 The Health of Missionary Families in China 

several times, and results checked, so that it is thought that 
the amount of error from faulty arithmetic is small. 

Securing information concerning family health through 
a questionnaire has certain limitations. Such a method would 
not be of value for any but an intelligent group of persons. 
Because the missionary body is an intelligent one, practiced 
in answering questionnaires, and realizing the importance of 
the problem of keeping well, this method of investigation is 
possible. Of course, certain data is more reliable than other. 
We can be sure that parents know the number of their chil- 
dren living and dead, and years of marriage. Other items, 
such as the various sicknesses, dates, etc., will not be so reli- 
able, and for the accuracy of these returns, allowance must 
be made. 

To offset the error which is associated with small bodies 
of figures, the data obtained has been viewed from many 
angles. 

The writer hopes to present the material in a form intel- 
ligible to the missionary body, many of whom are not accus- 
tomed to medical terms and mortality tables. To this end, 
the tables of most practical interest are illustrated by means 
of charts. In many tables, for the sake of clearness and brev- 
ity, only the figures giving the results of the computations 
are put down. Results are expressed usually to the nearest 
whole numbers only, and wherever possible, comparative re- 
sults are expressed in percentages. 



GENERAL FACTS CONCERNING DATA 

2,220 letters were sent out. Answers concerning 1,300 
marriages were received. The facts hereafter tabulated relate 
to 3,254 children of missionaries, including general facts con- 
cerning 36 children of 10 families, furnished by Dr. Elliott 
Illsgood of the Foreign Christian Society. These 36 are in- 
cluded in certain of the tables, only. All children have lived a 
total of approximately 28,000 years, nearly 18,000 of which 
have been spent in China. 

Are the statistics obtained representative of the whole of 
China? 

Table 1 represents the percentage of returns from the 
various provinces. It will be seen that there is considerable 
variation. Results for provinces near the head of the list will 
be more reliable than for those near the bottom, as they rep- 
resent a larger portion of the families in the province. 



The Health of the Children 



13 



Table 1 



PERCENTAGE ANSWERING QUESTIONNAIRE BY PROVINCES 



PROVINCE 


PER CENT 
ANSWERING 


PROVINCE 


PER CENT 

ANSWERING 


Kansu 


93 
76 
75 
73 
70 
64 
68 
61 
58 


Kiangsu _ 


58 
58 


ChihU . . 




54 


Shansi .. .. 


Hunan 

Kiangsi 

Hupeh 


52 




49 




49 


Fukien -. 


K wangtung 

Yunnan 


48 
47 




Manchuria _ 

All China 


42 




60 









Table 2 



PERCENTAGE ANSWERING QUESTIONNAIRE BY SOCIETIES 



SOCIETY 


Numlier to wliom 

Questionnaire 

was sent 


Number 
Replying 


Per cent 
Replying 




59 
64 
70 

223 
49 
92 

187 
71 

332 
69 
66 
53 

125 
59 
81 
91 

158 

270 


41 
51 
55 

159 
34 
63 

125 
48 

220 
42 
41 
31 
72 
30 
40 
42 
66 

108 


80 




80 




78 




71 




70 


Y. M. C. A. 


68 




67 




67 




66 




62 




62 




60 




50 




50 


Church Missionary Society 


60 


European C. I. M. ., 


45 




42 




40 







Table 2 shows the variation in the representation by soci- 
eties. The replies range from 40% to 80% — equidistant from 
the average of 60%. In general the English and European 
societies have a lower representation than the American. In 
appraising results, these factors of representation need to be 
borne in mind. 

Very few replies were received from those who were not 
in China. Presumably the questionnaire did not reach them. 
If we assume that tliis number is 15% to 20% of the total, 
we find that 75% to 80% of the married missionaries at the 
time in China answered the questionnaire, a high figure, as 
questionnaires go. 

If statistics were available for all the families, in place of the 60% 
here represented, they would probably show higher sickness and death rates 
than are here presented. This is because of the fact that the families which 
have been hardest hit by disease are not now on mission rolls, and conse- 
quently were not reached by this questionnaire. Again, of those who are on 
the mission roll, those who are most interested in the health of their chil- 
dren have been, in all probability, most successful in guarding against disease 
and are likely to be the ones to answer a questionnaire of this sort. (See 
Table 32.) 



14 The Health of Missionary Families in China 



THE NUMBER OF CHILDREN 

CHILDREN PER MARRIAGE 

It is pertinent to inquire whether missionaries have borne 
their full share of children. 



Table 3 



NUMBER OF CHILDREN BORN, NOW LIVING AND NOW DEAD, PER 
FAMILY OF MISSIONARIES, BY YEARS OF MARRIAGE 





No. of 
families 


NUMBER OF CHILDREN 


No. of years 
parents married 


Bom 


Now living 


Now dead 




Total 


No. per 
family 


Total 


No. per 
family 


Total 


No. per 
family 


0-9 

10-19 

20-29 

30 and over 

Years not stated 


G12 
389 
1G2 

57 
80 


984 
1,231 
664 
256 
119 


1.61 
3.16 
4.09 
4.49 
1.51 


881 
1,066 
540 
192 
115 


1.36 

2.74 

3.2 

3.39 

1.4 


92 

159 

130 

62 

10 


0.15 
0.42 
0.86 
1.08 
0.12 


Total 


1,300* 


3,254 


2.50 


2,794 


2.15 


453 


0.35 



*If the 20 second marriages were deducted, the children per family would number 2.54 in place of 2.50 

Table 3 gives the number of children bom to each family, 
arranged by the years of the parents' marriage. (Second 
marriages throughout are counted as separate families.) 

Investigations of the Immigration Commission^ for rep- 
resentative sections of the United States show that native 
white women whose parents were native, who are under 45 
years and have been married from 10 to 19 years, have an 
average of 2.7 children. Missionaries who have been married 
the same length of time have an average of 3.16 children. 

A more accurate comparison is with a group of American 
college teachers. Information concerning this group was 
kindly furnished by the Carnegie Foundation for the Ad- 
vancement of Teaching, and is summarized in Table 4. 



Table 4 SIZE OF FAMILIES OF FACULTY MEMBERS OF AMERICAN UNIVERSITIES 



RANK OF TEACHERS 


Number of 
families 


Total number 
of children 


Average 
number of 

children 
per family 


Families with children 




Number 


Average No. 
of children 


Instructors . 


635 
1,049 
1,338 


906 
2,169 
3,502 


1.42 
2.06 
2.61 


401 

839 

1,183 


2.25 


Professors — Intermediate Rank .. 


2.58 


Full Professors 


2.96 






Total- 


3,022 


6,585 


2.18 


2,414 


2.68 



The Health of the Children 



15 



Another fairly just comparison is with American college 
graduates. Many missionary wives are not college women, 
but it has been shown that college women have about the same 
number of children as their female relatives who have not 
gone to college.^ 

Table 5 NUMBER OF CHILDREN PER FAMILY FOR VARIOUS GROUPS IN COM- 

PARISON WITH MISSIONARY FAMILIES 



GROUPS 


Years of 
graduation 


Number 
married 


Total 
number 
children 


Average 
number 
children 


Rmit.h Cnllp^pl fradnatps 


1871-1901 

1867-1901 
1890-1901 
1842-1909 


1,016 
961 

178 
974 


1,285 

1,579 

307 

1,973 


1.26 


Vassar College Kraduates ._ . 


1.64 




1.71 




2.02 






Total women graduates 


1842-1909 


3,129 


5,144 


1.64 








1867-1886 






2.02 


Faculty members (Table 4) . - 


3,022 
1,300 


6,585 
3,254 


2.18 






2.50 









A glance at Table 5 shows that missionary families have 
a distinctly higher birth rate than these other educated classes. 
This in spite of the fact that nearly one-half of the marriages 
of missionaries were concluded less than ten years ago. For 
the 219 marriages which took place more than 20 years ago, 
the births average is 4.2. 

Among 85 Bryn Mawr^ graduates who had been married 
ten years or more, births averaged 2.2. Among 608 mission- 
aries of this class, the number is 3.5. 

If childless marriages are deducted, the average children 
per marriage is as follows: women college graduates, 2.13; 
college teachers, 2.68 ; missionaries, 2.80. 



Table 6 



NUMBER OF MARRIED YEARS PER LIVING BIRTH 
BY GROUPS OF SOCIETIES 





ALL FAMILIES 


FAMILIES WITH CHILDREN 


Groups of Societies 
(Those with lowest mortality 
first) 


Average No. 

years 

married 


Average No. 
children 


Average No. 
married 

years 
per child 


Average No. 

years 

married 


Average No. 
children 


Average No. 

married 

years 

per child 


First 


10.2 
10.9 
13.5 


2.14 
2.56 

2.88 


4.7 
4.1 
4.5 


10.7 
11.3 
13,5 


2.50 
2,89 
3.32 


4.2 


Second 


3.9 


Third -... 


4.1 






Total - 


11.4 


2.50 


4.6 


12.1 


2.80 


4.1 







The matter of birth rates may be presented in another 
way. Table 6 shows the average number of married years 



16 The Health of Missionary Families in China 

per child. The average for all families is 4.6 years. In con- 
trast, among 974 married graduates of Mt. Holyoke College 
and Seminary,* the child hearing married years per child num- 
ber 6.5. That is, births are two years further apart than with 
missionaries, in spite of the fact that only child-bearing mar- 
ried years are counted. 



Table 7 



NUMBER OF CHILDREN PER FAMILY BY SOCIETIES 





All Families 


Families Without Children 


Average No. 

children 

of families 

with 

children 


SOCIETY* 


Total 
number 


Total No. 
of children 


Average No. 
of children 


Number 


Per cent 


Am. Bapt.. North 

Am. Ch. Mission 

Am Meth., North -.. 


45 
42 
73 
34 
63 
233 


99 

78 

197 

82 

120 

474 


2.20 
1.85 
2.70 
2.41 
1.90 
2.03 


5 
11 


2 

7 
42 


11.01 
26.1 
8.2 
5.8 
11.1 
18.0 


2.47 
2.52 
2 94 
2.56 


Y.M.C.A 

Other Am. Societies 


2.14 
2.47 


Total 1st group 


490 


1,050 


2.14 


73 


14.9 


2 50 






Canadian Meth. 


48 
41 
126 
55 
53 
34 


134 

94 
314 
137 
138 

98 


2.79 
2.29 
2.41 
2.49 
2.60 
2.88 


3 

8 
14 
9 
6 



6.2 
19.5 
11.1 
16.4 
11.3 


2 97 


Ch. Miss. Soc. 


2 87 


Am. Pres., North . _ _ 


2 SO 


Am. Luth. Societies 

Am. Board- 


2.99 
2 . 93 




2 88 








Total 2nd group 


357 


915 


2.56 


40 


11 2 


2.89 






Other Eng. Soc . 


108 
156 
29 
67 
43 
41 


291 
449 
106 
171 
119 
139 


2.69 
2.87 
3.65 
2.59 
2.76 
3.39 


12 
25 
3 
10 

7 
2 


11.1 
16.0 
10.3 
15.1 
IG.2 
4.8 


3.38 


China Inland Mission 

Am. Pre.'!., South. 

Other European Soc 

Am. Bapt., South 

European C. I. M 


3.42 
4.07 
3.05 
3.30 
3.56 


Total 3rd group 


444 


1,275 


2.88 


59 


13.3 


3 32 






Society not stated 


9 


14 


1.55 
















All societies .. 


1,300 


3,254 


2.50 


172 


13.1 


2 80 







*For basis of division into Societies, see explanation following Table 26. 



Tables NUMBER OF CHILDREN PER FAMILY, AND PERCENTAGE OF FAMILIES 
WITHOUT CHILDREN, BY GROUPS OF SOCIETIES OF VARIOUS NATIONS. 





All Families 


Families 
without 


Average 


SOCIETIES 


Number 


Per cent 
of total 


Children 


children 


per family 

having 
children 




Total 
number 


Average No. 
per family 


No. 


Per cent 




762 
265 
107 
156 


59 

20 

8 

12 


1,782 
699 
310 
449 


2.33 
2.63 
2.89 
2.88 


110 
25 
12 
25 


14.4 
9 
11 
16 


2 73 


English and Canadian 


2.91 
3 ''6 


China Inland _ 


3.42 



Throughout this study, "Europe" refers to continental Europe. 



The Health of the Children 17 

Because the mission body is composed of many nation- 
alities, the comparison with American statistics is not quite 
fair. In Table 7, division is made into various societies and 
groups of societies, and these are, in turn, combined in Table 
8, according to the nationality of the societies. 

It will be seen (column 3 of Table 8) that English and 
European societies have more children than American. The 
average of 2.33 for American societies is not, however, much 
below the average for the whole — (2.50). This is because the 
families of American societies comprise nearly 60% of the 
total. 

The statement has been made that the upper class of Eng- 
lish society has 2.2 children per family. English and Cana- 
dian missionary societies have 2.63 children per family. 

CHILDLESS MARRIAGES 

A corollary to this question is the proportion of the mar- 
riages which remain childless. In the class of American 
women of native parentage and married from 10 to 19 years,^ 
the percentage is 13.1. Among missionaries married the same 
length of time it is 6.2, less than half. 

All missionaries show 13.1 per cent of the marriages so 
far childless. Among teachers in American colleges the per- 
centage is 20. Among 3,594 married women graduates of 
eight American colleges,^ who had graduated ten or more 
years previously (classes 1870-1901) the percentage without 
children is 31.4. 

In sharp contrast, missionaries who have been married 
ten years or more show only 5.9 per cent childless marriages. 

These figures are of great interest, as they show (1) that 
missionaries have not hesitated to assume the responsibilities 
of parenthood, and (2) the small percentage of infertility in a 
group of persons in which both parents are free from the 
sterilizing venereal diseases. (''Gonorrhea is the cause of 
70-75 per cent of sterility in married life, not of choice."^) 

It is of interest to inquire not only the average number 
of children per family, but also the number of children in 
each family. 



18 The Health of Missionary Families in China 

SIZE OF FAMILIES 

Table 9 PER CENT OF FAMILIES WITH SPECIFIED NUMBER OF CHILDREN BORN, 

BY YEARS OF PARENTS' MARRIAGE 



Number of 
j'ears 


Families 


Per cent of families having specified number of children 
born 


parents 
married 


Total 
number 


Per cent 
of total 





1 


2 


3 


4 


5 


6 


7 


8 


9 


10 


11 


12 


0-9 


612 
389 
162 
57 
80 


46.6 
28.9 
12.9 
4.4 
6.2 


17 
6.2 
2.5 
3.5 

46.2 


32.7 
12.4 
5.6 
1.7 
7.5 


29 

18.5 

10.4 

17.6 

22.5 


15.2 
22.4 
19.7 
14.1 
S.75 


5.1 
17.1 
27.7 
17.6 

6.3 


.6 
15 

14.1 
17.6 
6.3 
















10-19 

20-29 

30 and over 

Years not stated 


5.3 
8.0 
12.2 
1.3 


1.8 
4.3 
8.5 
1.3 


.5 
3.1 
1.7 


.3 
1.7 
5.3 


~".l 


'i'7 


% 
.6 


Total 


1,300 


99 


13.1 


20 


22.2 


17.4 


12.2 


7.6 


3.2 


1.5 


.74 


.52 


.07 


.07 


.15 



Table 9 gives the percentage of families having various 
numbers of children. 101 families have five children, 43 have 
six, 20 have seven, 9 have eight, 7 have nine, one has ten, one 
eleven, and two have twelve. 

For those married ten years or longer, the largest num- 
ber (20.9%) have three children, closely followed by those 
with four children (20%). Table 10 gives the contrasting fig- 
ures for American college teachers and married graduates of 
Vassar and Biyn Mawr colleges. In this table the families 
having more than four children for the various groups are: 
Vassar and Bryn Mawr graduates, 3.5% ; college teachers, 
8.5% ; missionaries, 13.6%. 



Table 10 SIZE OF FAMILIES OF AMERICAN COLLEGE TEACHERS, OF WOMEN 
COLLEGE GRADUATES AND OF MISSIONARIES 



GROUPS 


Number 
reporting 


Per cent of families having specified number of chil- 
dren born 







1 


2 


3 


4 


5 


6 


7 


8 


9 


10 


11 


1! 


Full professors 


1,338 

1,049 

635 


12 
21 
37 


17 
16 
15 


19 
24 
27 


24 
22 
13 


17 
12 

6 


9 
4 
9 


3 

2 
6 


.3 
.1 


.4 
.1 


.2 


.1 




































Total college teachers 


3,022 


20 


16 


22 


21 


13 


6 


2 


.2 


.2 


.1 


.03 














1,703 
1,300 


38 
13 


24 
20 


19 

22 


11 
17 


4 
12 


2 

8 


.8 
3. 


.3 
1.5 


.1 
.7 










Missionaries _ 


.5 


.07 


.07 


.15 



Among the 3,594 college women^ who graduated ten or 
more years ago (classes 1881-1901) the percentage with two 
or more children is 46.3; among missionaries married ten 
years or more, this percentage is 80. Here again allowance 
needs to be made for the European societies, among whom the 
largest families occur. 



The Health of the Children 



19 



Table 11 PERCENTAGE OF FAMILIES WITH SPECIFIED NUMBER OF CHILDREN NOW 
LIVING, BY YEARS OF PARENTS' MARRIAGE 



Number of years 


Number 
of families 


Per cent of families having specified number of children 


low living 


parents married 





1 


2 


3 


4 


5 


6 


7 


8 


9 


0-9 


612 

3S9 

162 

57 

80 


19.1 
8.2 
3.6 
3.5 

44 


35.6 
14.1 
16.1 

8.8 
11 


29.2 
22.5 
16.6 
21 

22 


12 

23.2 

22 

29.8 

11 


3.8 
18.8 
21.4 
14 

4.9 


.3 
9.7 
10.1 
5.3 
3.7 










10-19 


15 
3.6 
10.5 
3.2 


1.8 
4.8 
5.3 


1.7 




20-29 .. 


.6 


















Total 


1,300 


15 


23.8 


24.7 


17.4 


10.9 


4.8 


1.3 


1.3 


2 


.07 











Table 11 shows the percentage of families having various 
numbers of children now living. 



Table 12 



PERCENTAGE OF FAMILIES WITH SPECIFIED NUMBER OF CHILDREN NOW DEAD. 
BY YEARS OF PARENTS' MARRIAGE 



Number of years 


Number 
of families 


Per cent of families having 


specified number of children now 


dead 


parents married 





1 


2 


3 


4 


5 


6 


0-9 


612 
389 
162 

57 
80 


87.4 
67.8 
51.9 
36.8 
92.4 


10.3 
25.3 
25.9 
36.8 
3.7 


2.1 
5.3 
15.4 
15.6 
2.5 


,1 
.1 

4.9 

5 

1.3 








10-19 


.1 
12 
1.6 






20-29 




.6 




3.4 
















Total 


1,300 


75.2 


17.5 


5.3 


1.3 


.3 


.2 


.1 



Table 13 



PERCENTAGE OF FAMILIES WITH SPECIFIED NUMBER OF CHILDREN DEAD, 
BY SOCIETIES 



SOCIETY 


Number 
of families 


Per 


cent of families having specified number of chil- 
dren dead 







1 


2 


3 


4 


5 


6 




45 

42 
63 

223 
34 
73 
48 

126 
41 
55 

108 
53 
66 

156 
34 
43 
29 
41 


87 
86 
86 
82 
80 
79 
77 
77 
76 
74 
73 
71 
71 
69 
67 
60 
60 
49 


11 
14 
12 
14 
15 
19 
16 
16 
22 
17 
21 
19 
18 
19 
20 
23 
27 
27 


2 




















Y M C. A 


1 
3 
4 
1 
4 
5 
2 
6 
5 
9 
4 
8 
9 

12 
3 

21 


1 
.5 
























Am Meth., North 












2 

1 








Am Pres North 


















2 




2. 




















3 

1.3 

3 


1.3 
1.3 


'.h' 


1.3 




















3 



























20 The Health of Missionary Families in China 

Table 12 shows the families having various numbers of 
children now dead, by years of parents ' marriage, and Table 
13 shows the same facts by societies. 

Three-fourths of all families have had no deaths among 
children. Of those who have had children die, less than a 
third have had more than one. Three families have lost four 
children, three have lost five, and one has lost six. These 
figures are exclusive of still births. 

In Table 13 the societies are arranged in order, with those 
showing the largest percentage of families without death at 
the top. 



Table 14 



AGES AND YEARS IN CHINA 

CHILDREN— PERCENTAGE OF YEARS IN CHINA, BY PROVINCES 



PROVINCE 


Percentage of time 
in China 


PROVINCE 


Percentage of time 
in China 




55.8 
66.5 
69.7 
67.1 
74.5 
72.6 


Hupeh 

Hunan 

Kweichow 


60.6 




73.7 


Chihli. 


83.1 


Shansi.. .. 


59.4 










68.6 








North China . . . 


68.2 


59.9 




Kwangtung 

Yunnan 


56.5 


Kiangsu.. . _. .. 


72.9 
74.9 
79.8 
66.1 
76.9 


72.3 








5S.2 




All China.- - - 






66.9 









Table 14 shows the percentage of the children 's life which 
has been spent in China, by provinces. Children in South 
China spend 10 per cent less time in China than those in North 
and Central China. 



The Health of the Children 



21 



Table 15 NUMBER OF YEARS OF LIFE OF CHILDREN, AND YEARS SPENT IN 

CHINA, BY SOCIETIES 





YEARS OF AGE 


YEARS IN CHINA 


SOCIETY 


Number 
reported 


Tola! 

years 
of age 


Average 
years 
of age 


Number 
reported 


Total 

years 

in China 


Average 

years 
in China 


Percentage 
of time 
in China 


Am. Bapt., North - 


91 

73 

192 

SO 

120 

426 


827 
424 

2,147 
856 
538 

3,101 


9.09 
5.81 
12.17 
10.69 
4.48 
7.27 


90 

74 

182 

79 

120 

409 


487 
209 

1,394 
419 
308 

2,742 


5.41 
2.82 
7.66 
5.58 
2 56 
6.70 


59 
50 
65 


Am. Church Mission _. 

Am. Meth., North -. . - 


London Mission 

Y.M.C.A.--. 

Other Am. Soc 


48 
57 

88 








y»2 


7,893 


8.03 


'j64 


5,559 


5.b2 








Canadian Methodist 

Church Mission Soc 

Am. Pres., North- 


m 

90 
308 
137 
132 

98 


69-2 

763 
2,588 

668 
1,195 

997 


5.16 
8.48- 
8.40 
4.98 
9.05 
10,18 


133 
89 
304 
137 
137 
90 


503 

416 

1,737 

491 

803 
502 


3.78 
4.67 
5.71 
3.73 

5.86 
5.57 


73 
55 
67 


Am. Luth. Soc. 


71 


Am. Board Mission 

Eng. Baptist , 


69 
50 






Total 2nd group... _ 


899 


6,903 


7.69 


890 


4 452 


5. 








Other Eng. Soc. 


289 
449 
94 
169 
112 
139 


2,694 
4,728 
955 
1,641 
1,717 
1,015 


9.32 
10.53 
10.16 

9.71 
15.33 

7.30 


283 
440 
95 
160 
109 
135 


1,664 
3,391 
600 
940 
7!0 
623 


5.bV 
7.70 
6.31 
5.90 
6.51 
4.61 




China Inland Mission 

Am. Pres., South _ 


71 
02 


Other EuropeanSoc 

Am. Bapt., South 


57 
42 


European C. I. M 


63 


Total 3rd group. 


1,252 


12,399 


9.90 


1,222 


7,786 


6.37 


63 






Society not stated 


14 


96 


6.85 


14 


91 


6.50 


94 






Total 


3,149 


27,291 


8.65 


3,030 


17,888 


5.8 


67 






Years not stated. . 


105 


903 


8.65 


174 


1,009 


5.8 




(Average taken) 




Total all Societies 


3,254 


28,194 


8.65 


3,254 


18,897 


5.8 


67 







Table 15 shows the age of children, years in China and 
percentage of time in China by societies, the societies being 
arranged in order of mortality of children, with those having 
the smaller percentage of deaths at the top. The relation of 
age of children and percentage of time in China to mortality 
is shown in Figure 12. 

In this and some other tables, e.g.. Table 26, the number not answering 
the point in question is entered in the table. In most of the tables, in order 
to save space, this is not done, so that the total children, total deaths, etc., at 
the bottom do not in all the tables coincide. As has been pointed out, there 
is in some tables a small percentage of error due to the fact that almost all 
the arithmetic was done by head rather than by machine. 



22 The Health of Missionary Families in China 











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The Health of the Children 



23 



Table 16 gives the number of children now living at vari- 
ous ages, by provinces. The total for each year is represented 
in Figure 7. 

MASCULINITY 

The number of children dealt with is not large enough 
to make division of statistics into male and female of value. 
It is of interest, however, to note the relation of total male 
and female births and deaths. In Table 17 the births and 
deaths are divided into groups of provinces. Group 3 com- 
prises the provinces having the highest child mortality and 
Group 1 those with the lowest. In those where the death rate 
is highest the number of boys born is lowest. Of the total 
births there are 1,032 boys to 1,000 girls, about the usual pro- 
portion. For every 1,000 girls who have died, 1,267 boys have 
died. This means that the living boys and girls are equal in 
number — 1,310 of the former to 1,312 of the latter. 



Table 17 



RELATION OF MALE TO FEMALE BIRTHS. BY GROUPS OF PROVINCES 





Total living births 


Number 
male 
births 

to 1,000 
female 


Total deaths 




Number 
male 


GROUP 


Male 


Female 


Sex not 
stated 


Male 


Female 


Sex not 
stated 


deaths 
to 1,000 
female 


3 
2 

1 


561 
572 
414 


573 
557 
369 


50 
61 
46 


979 
1.027 
1,122 


no 

87 
40 


95 
63 
29 


14 
6 
1 


1,158 
1,381 
1,379 


Total 


1,547 


1,499 


157 


1,032 


237 


187 


21 


1,267 



Twins are reported nineteen times (.6% of the total). In six cases 
there were twin sons, in seven cases twin daughters, in five cases half and 
half, and in one case sex was not stated. 



CONDITIONS AFFECTING CHILDREN 

There is a variety of conditions which react adversely 
on foreign children in China. These are, briefly: 

(1) Low moral atmosphere — of non-Christian Chinese 
servants, etc., and, in port cities, of non-Christian foreigners. 

(2) Conditions which may affect the nervous poise of the 
child: isolation, occasionally fright from Chinese mobs, and 
almost constantly, unnatural tension over food and drink. 

'*My father is dead," said one child. Quickly her play- 
mate asked, "What did he eat?" 



24 The Health of Missionary Families in China 

"My," said another little girl, on reaching a Vancouver 
hotel en route from China, "isn't it grand to take a bath in 
drinking water?" 

(3) Lack of proper educational and social advantages. 

(4) Diflficulty in maintaining physical health because: 
{a) of climate, sun, lack of space for play; {h) because of diffi- 
culty in obtaining good fresh milk and other elements of a 
balanced diet or sufficient vitamins from fruit which is pared 
and vegetables which are cooked, and (c) because of the prev- 
alence of infectious diseases. 

All these phases of child life are important. This study 
is concerned chiefly with the question of physical health. 



COMPARATIVE MORTALITY 

MISSIONARIES AND CHINESE 
Table 18 MORTALITY OF CHILDREN OF MISSIONARIES AND OF LOWER CLASS CHINESE 





Total 
Births 


Number of Deaths 


Number of Deaths 
Per 1,000 Births 


CHILDREN OF 


Total 


0-5 
Years 


0-1 
Year 


Total 


0-5 
Years 


0-1 
Year 




3,254 
8,468 


451 
2,751 


366 
2,203 


196 
1,321* 


139 
325 


121 

272 


60 




156* 







♦Number infant deaths unreliable because of Chinese method of counting ages. 




Figure 1. Mortality of 
Children of Mission- 
aries and of lower 
class Chinese. (Illus- 
trating Table 18.) 



How does the death rate among mis- 
sionary children compare with that of 
the Chinese among whom they live? In 
order to answer this question, the writer* 
had inquiry made of 4,000 male patients 
who attend the dispensary of the Union 
Medical College in Peking. Compara- 
tive mortality is shown in Table 18 and 
Figure 1. 

How do the rates for children of mis- 
sionaries and children of non-missionary 
foreigners compare? The writer knows 
of no data for children. Statistics for a 
small number of persons in Africa^ 
showed the following number of deaths 
per 1,000 persons: European officials, 
8.10; non-officials, 8.49; missionaries, 
31.7. 



The Health of the Children 



25 



MISSIONARIES IN CHINA AND JAPAN 

Table 19 MORTALITY OF MISSIONARY CHILDREN IN CHINA AND IN JAPAN 





Number of 
Living 
Births 


Number of Deaths 


Number of Deaths 
Per 1,000 Living Births 


COUNTRY 


Total 


0-5 
Year3 


0-1 
Years 


Total 


0-5 
Years 


0-1 
Years 


China 


3,254 
377 


451 
36 


366 
28 


196 
20 


139 
95 


112 
74 


60 


Japan 


53 




How does the death rate among chil- 
dren in China compare with that in 
other mission fields? The writer has 
sent a questionnaire to all missionary 
families in Japan. The answers so far 
received, as shown in Table 19 and 
Figure 2, reveal a much lower rate in 
Japan than in China, the largest dif- 
ference occurring in children over 1 
and under 5 years. Mission doctors 
in Seoul are making a similar study 
for missionaries in Korea. 

How does the rate among mission- 
ary children in China compare with 
rates in the home lands? 

It is hardly fair to compare the mis- 
sionary group with the general popu- 
lation, for the following reasons : Missionaries are far above 
the average in education and intelligence; they have passed 
physical examinations ; they are free from the diseases which 
lie behind such a large proportion of the deaths of children, 
viz., the venereal diseases and alcoholism. 

Another difficulty is that general mortality statistics are 
based on the number of persons dead to the number living, in 
any geographical or age group for a certain year, whereas in 
this study births and deaths extend over many years and the 
number living in any one year is not known. 

In order to secure figures for accurate comparison, the 
writer is at present sending questionnaires similar to those 
used in China and Japan, to ministers and educated church 
members in America. A comparison of health conditions in 
these three groups will be presented in a later paper. 



Figure 2. Mortality of 
missionary children in 
China and Japan. (Illus- 
trating Table 19.) 



26 The Health of Missionary Families in China 

In the meantime, there is some value in comparing results 
obtained with available government statistics. The mission- 
aries participating in this study have been married an average 
of 11.4 years. Wherever possible, statistics corresponding to 
this time period, rather than the latest returns, are used. 

INFANT MORTALITY 

First : in regard to infant mortality. 

This term means in government statistics the number of infants under 
one year old who have died in a certain year per 1,000 babies born alive dur- 
ing that same year. In this study it means the number of infants who have 
died per 1,000 born. Instead of one year, it covers a number of years. There 
are two sources of error. First, there are 177 infants not yet a year old. 
Probably five of these will die before reaching a year. This would raise the 
infant mortality from 60.2 to 61.7, a small difference. The second possible 
source of error is larger. The parents of 15 babies made the report "Died 
at birth." It is assumed that these babies were dead when born, and they 
are therefore classed among the still births. If, however, they were alive 
when born, they should be classed as infant deaths, and this would raise the 
infant mortality rate from 60.2 to 64.7. This indefiniteness concerning infants 
dying at birth is a source of error in most mortality statistics. 



Table 20 

PERCENTAGE OF INFANT DEATHS OCCURRING BY MONTHS FOR UNITED STATES' AND VARIOUS 
CLASSES OF ENGLISH SOCIETYs, AND FOR MISSIONARY CHILDREN 





Infant 
Mortality 


Infant Deaths Occurring in Specified Months 




Under 
1 Mo. 


1-2 


3-5 


6-11 




171 
151 
90 
76 
69 
42 
60 


Percentage 
27 
24 
50 
39 
44 
50 
34 


Percentage 
IS 
21 
17 
19 
21 
14 
6 


Percentage 
21 
19 
15 
17 
20 
14 
21 


Percentage 
34 




35 


United States children of native born mothers 


IS 

24 




15 


Professional and business group in England- . 


22 
39 







Table 20, Column 1 gives infant mortality rates for vari- 
ous groups of English and American society. 

In this comparison, missionary infants show up very well 
(60 against 42 for the children of English professional and 
business men). There is a striking difference, however, in the 
distribution of deaths during the first year, as shown in Table 
21 and Figure 3. 



The Health of the Children 



27 



Table 21 INFANT MORTALITY OCCURRING BY MONTHS FOR TWO CLASSES OF 

ENGLISH SOCIETYio AND FOR MISSIONARY CHILDREN 




Number 
of Births 


Number of Deaths Per 1,000 Births 




0-1 
Year 


0-1 
Month 


2-3 

Months 


4-6 

Months 


7-12 
Months 


Factory laborers in England 

Professional and business groups in England 
Missionaries in China.. _ 


80,919 
8,658 
3,20t 


171 

42 
60 


46.3 

21 

20.9 


31.7 
6.2 
3.4 


36.4 
6.2 
12.8 


56.8 

8.1 
23.4 




Figure 3. Infant Mortality by Months 
for two classes of English Society 
and for missionary children. (Illus- 
trating Table 21.) 



In communities where in- 
fant death rates are low, a 
larger proportion of the in- 
fant deaths occur in the 
first months of life than in 
communities where rates 
are higJi." (This because of 
the unpreventable accidents 
and defects at birth.) 
Among missionary chil- 
dren, however, 39% of the 
deaths occur in the last half 
of the year, giving a curve 
which follows that of Eng- 
lish factory laborers. The 
cause of this upward turn 
is shown in Table 50. 31 of the 67 deaths during these six 
months were due to intestinal infection, viz., dysentery, infec- 
tious diarrhoea, cholera, and typhoid. Were it not for these 
infections, the infant rate would nearly equal that of the fav- 
ored English class, which it actually surpasses for the first 
six months. Breast-fed babies have no right to these infec- 
tions. Many mothers complained that they were able to nurse 
their babies but a few months, which fact, with the consequent 
artificially prepared food, accounts in large measure for the 
rising death curve after the first six months. It has been 
shown that the mortality among bottle-fed infants in New 
York is 12 times what it is among the breast-fed.^- The ratio 
in China, where clean, fresh milk is hard to get, and dysentery 
is rife, is probably not less. The extent and cause of this 
inability to nurse needs special investigation. If it is found 
that too much mission work is responsible, the price paid for 
that work is a high one. 



28 The Health of Missionary Families in China 

MORTALITY IN EARLY CHILDHOOD 

The hope aroused by this comparatively low infant mor- 
tality of finding a low death rate among children is quickly 
dashed. In comparing various city rates with the English 
"Healthy District Life Table," English health officers have 
shown that children are most affected by an unhealthy envi- 
ronment during the third year of life/^ From this high point 
the curve sinks gradually to the tenth year, when unhealthy 
cities show little more mortality than the ** Healthy Districts." 
This finding is verified in these statistics. 



Table 22 


MORTALITY FOR THE FIRST TEN YEARS AMONG MISSIONARY CHILDREN 




AND AMONG CHILDREN IN AMERICA AND ENGLAND 








Number of Deaths Per 1,000 Living 




Number of 




) 






Missionary Children 




1 Children of 


General 


Year 


Alive at Begin- 


Deaths During 


Children of 


Native White 


Population 


of Age 


ning of Year 


That Year 


Missionaries 


Parents, U. S. A. 
1900 


England and Wales 
1904-1908 


0-1 


3,212 


194 


60 


133 


117 


1 


2,841 


87 


31 


32 


35 


2 


2,587 


48 


18 


14 


14 


3 


2,332 


17 


7 


9 


9 


4 


2,147 


19 


9 


7 


7 


5 


1,967 


12 


6 


6 




6 


1,820 


15 


8 


5 




7 


1,673 


5 


3 4 




8 


1,534 


10 


6 '. 3 




9 


1,399 


4 


3 1 , 


---- 





Figure 4. Mortality for the first ^^|"^^ ^- Mortality of the first 
fivP vears imone rnism-nnarv rhil ^^® ^^^^^ among missionary chil- 

JLr, oi^r.h^U. Tf ^i?-^! Lf dren and children in England and 

dren and children of white native- Wales (Illustratin- Table 2"? ^ 

born Americans. (Illustrating ^^^^^- UHustratm^ iable 16.) 

Table 22.) 

Infant deaths, as shown in Table 22 and Figures 4 and 5, 
for the general population of England^'' and the native white 
population of the United States,^ are more than double the 
missionary rate, but after the first year deaths are about the 
same. 



The Health of the Children 



29 



Table 23 CHILD AND INFANT MORTALITY IN CITY AND COUNTRY DISTRICTS OF 
ENGLAND (1914; COMPARED WITH THAT OF MISSIONARY CHILDREN 




NUMBER OF DEATHS PER 1,000 LIVING 




0-1 Year j 1 Year 


2-3-4 Years 




130 
66 
60 


55.7 
11.7 
30.6 


13.5 




3.8 




11.2 








If, as in Table 23, we compare our 
rates with the cities of North England,^" 
we find the same condition, a relatively- 
high rate for missionary children for 
the ages 2, 3 and 4. If we compare 
with the rural districts of South Eng- 
land, where infant death rates are near- 
ly as low as missionary, we find that 
during the second year missionary rates 
are more than double, and during the 
third, fourth and fifth years are three 
times the rates of the country districts 
of England. This is illustrated in 
Figure 6. Differences in the methods of 
arriving at results make comparison of 
the two curves of more value than com- 
parison of any two points on the two 
curves. These comparisons show clearly an excessive mortal- 
ity for the second, third and fourth years of life. These years, 
rather than the first year, are, compared with the homeland, 
the dangerous ones for missionary children. These compari- 
sons are made with English and American statistics rather 
than with European, because only about one-tenth of the chil- 
dren are from European societies. Except for Germany, 
which has a high rate, infant mortality rates in Northern 
European countries are lower than those in England and 
America. 

For the five-year period from 1906 to 1910, the following 
was the infant mortality rate in various countries ■}* United 
States, 124; England and Wales, 117; Netherlands, 114; Scot- 
land, 112 ; Denmark, 108 ; Sweden, 78. 



Figure 6. Mortality in 
first five years among 
Missionary Children 
and children in rural 
districts of England. 

(Illustrating Table 23.) 



30 The Health of Missionary Families in China 



Table 24 



PERCENTAGE OF CHILDREN DYING AND PERCENTAGE NOW LIVING, 
AT VARIOUS AGES 



AGE 


Percentage Dying 
At Specified Age 


Percentage Now Living 
At Specified Age 


0-1 _.. ..._ 


43.6 

19.6 

10.8 

3.8 

4.2 

2.7 

3.4 

1.1 

2.2 

.9 

4.2 

3.8 


6.6 


1 .. _ 


6.6 


2 


7.7 


3 ... 


6.1 


4 


6.1 


5 . . 


6.2 


6.... 


5. 


7 


5. 


8 


4.7 


9 


4.2 


10-19 _ 


26. 




14.4 






Total-- 


100.3 


99.1 







D EA D - PERCEN TAQE OP TOTAL NUMBER. DEAD 
LIVINQ- PERCENTAGE OF TOTAL NUMBER. UIVINQ 



U3. 



IIM 



Q 



Sfl 



13 ^ 



^ 1 M « 






<? lO-lcj 7.0 + 



Figure 7. Percentage of children dying and percentage now 
living at various ages. (Illustrating Table 24.) 



Table 24 and Figure 7 show the number of children dying 
at various ages in relation to the number now living. 



FACTORS IN CHILD MORTALITY 

In any analysis of the causes of child mortality, there are 
numerous factors to be considered. Those on which this study 
throws some light will be considered first. 



The Health of the Children 



31 



GEOGRAPHICAL LOCATION 

In Table 25 is presented the number and percentage (or 
per thousand) of children dying in the various provinces in 
which parents reside. 

In the cases in which parents have lived in various provinces, their 
residence is considered to be that in which they have lived longest. This 
Involves some error, as some children have contracted disease while away 
from home at school. To offset this error and to provide larger figures for 
generalization, the IS provinces are grouped into three sections — North, 
Central, and South China. The basis for this division is the statement of 
the China Year Book,i5 defining North China as north of the 35th parallel. 
South China as south of the 28th parallel, with Central China lying between. 

Returns from some of the provinces are too small to make tabulation 
of value. Thus the returns from Yunnan and Kwangsi are included in those 
from Kwangtung; those from Kueichow with Hunan; and those from Sin- 
kiang and Mongolia with Manchuria. 

Western China means practically Szechuan, for returns from other 
western provinces are scant. The provinces in Table 25 are arranged from 
north to south. 

It will be seen that, in general, the highest rates of mor- 
tality are in the northern provinces. 



Table 25 



MORTALITY OF CHILDREN BY PROVINCES ARRANGED BY GEOGRAPfflCAL 

SECTIONS 



PROVINCE 


Total 
Number 
of Living 

Births 


Number of Deaths 


Number of Deaths Per 
1,000 Living Births 




Total 


0-5 
Years 


0-1 
Year 


Total 


0-5 
Years 


0-1 
Year 


Manchuria 


85 
289 
270 
154 
84 
76 


20 
55 
39 
29 
23 
12 


17 

39 

32 

28 

19 

7 


9 

22 
16 
24 
10 

3 


235 
190 
144 
195 

274 
158 


200 
135 
118 
182 
226 
92 


106 




76 


Chihii 


59 


Shansi- 


91 




119 




39 






North China 


958 


178 


142 


74 


186 


148 


77 






Kiangsu.. 


448 
94 
17G 
229 
70 
196 
216 
311 


01 

7 

19 
41 

7 

27 
26 
41 


50 
7 
13 
33 
fi 
19 
22 
35 


27 
4 
9 

16 
3 
9 

11 

19 


137 
75 
106 
179 
100 
137 
120 
131 


112 
75 
73 

144 
82 
97 

102 

112 


60 




43 


Chekiang . 


51 


Honan .. 


78 




42 


Hupeb.. . 


46 


Hunan, Kueichow 


50 


Szechuan- . 


61 






Central China 


1,740 


228 


185 


98 


130 


106 


56 






Fukien .. 


182 
324 


12 
30 


9 

27 


7 
17 


68 
92 


49 
87 


38 


Kwantung, Yunnan 


52 


South China .. 


506 


42 


36 


24 


83 


71 


47 






Total— All China 


3,204 


448 


363 


196 


139 


113 


61 







32 The Health of Missionary Families in China 




Figure 8. Mortality of Missionary Children by provinces. (Illus- 
trating Table 25.) 



Table 25 is illustrated by Figure 8, and also by the frontis- 
piece. Note that provinces with the lowest rates (the first five 
in the chart) have a relatively small number of children dying 
between the ages of 1 and 5. In columns representing prov- 
inces with high rates this portion is greatly elongated, showing 
again that this is the danger age for children in China, as 
compared with those at home. This finding of excessive rates 
in North China, rather than in the south, was such a surprise 
that the question has been examined from a number of angles, 
as will be seen later. 



The Health of the Children 



33 



Figure 9 shows the mortality for the three sections of 
China. To make sure that the high mortality for North China 
was not due to a longer residence by the children in that sec- 
tion, the number of deaths per 1,000 years of residence was 
calculated and compared with the mortality rates based on 
number of births. Figure 10 shows that, viewed from either 
angle, North China has the highest rates. If Honan were 
counted with North China, the difference between deaths for 
North and Central China would be increased by 5 per 1,000 
births. 




Figure 9. Mortality of chil- 
dren by geographical sec- 
tions. (Illustrating Table 
25.) 





^^ . -.PER 1000 rtARS 

\ . ■ PIB. 1000 Bimii 


Z 

c 
s 


o 



o 

K 110 


\\ 
\\ 
\\ 




a. 
r 
o 

eo 




h 



J 


o 

K 

c 

i. 

z 
o 




?, 

r 
O 


CMIMA 


NORTH 1 CtNTHAl. 1 bOUTM 





Figure 10. Deaths of children per 
1,000 births and per 1,000 years of 
residence by sections. 



MISSIONARY SOCIETIES 

In Table 26 and Figure 11 the tabulation is made accord- 
ing to missionary societies. Societies reporting 75 or more 
children are listed separately. Societies are arranged in 
order of the total mortality, the lowest at the top. For fur- 
ther analysis societies are arranged in three groups of six 
societies each. 



34 The Health of Missionary Families in China 



Table 26 



MORTALITY OF CHILDREN, BY SOCIETIES 





Number 
Living 
Births 


Number of Deaths 


Number of Deaths Per 
1,000 Living Births 


SOCIETY 


Total 


0-5 
Years 


0-1 
Year 


Total 


0-5 
Years 


0-1 
Year 


Am. Baptist, North 

Am. Church Mia. 


99 
78 
197 
82 
120 
474 


7 
6 
16 
7 

12 
52 


7 
6 
15 
5 
11 
39 


5 
2 
7 
3 
8 
21 


71 
77 
81 
86 
100 
110 


71 

77 
76 
61 
92 
82 


50 
26 


Am. Methodist, North 


35 
37 


Y. M.C. A.. 

Other Am. Soc. . 


66 
44 






Total — 1st group 


1,050 


100 


83 


46 


95 


79 


44 






Canadian Methodist 

Church Mis. Soc... 


134 
94 
314 
137 
138 
98 


15 
11 
38 
18 
20 
10 


14 
11 
29 
15 
15 
14 


8 
7 
14 
5 
6 
7 


112 
115 
121 
131 
145 
161 


104 
115 
92 
109 
108 
142 


60 

78 


Am. Pres., North 


45 


Am. Lutheran Societies 

Am. Board Mis 


36 
43 


Eng. Baptist. - 


71 






Total — 2nd group 


915 


118 


98 


47 


128 


107 


61 






Other Eng. Soo 


291 
449 
105 
171 
119 
139 


40 
80 
20 
34 
27 
32 


33 
57 
15 
30 
21 
29 


18 
32 
9 
16 
13 
15 


172 
178 
190 
205 
228 
230 


115 
127 
140 
175 
176 
209 


63 


China Inland Mia 


66 


Am. Prea., South 


84 


Other European Soc 

Am. Baptist, South 

European C. I. M 


94 
109 
108 






Total— 3rd group. 


1,275 


233 


185 


103 


182 


146 


81 






Society not stated. . 


14 




























Total all Societle« 


3,254 


451 


366 


196 


139 


112 


60 








Figure 11. Mortality of children by Societies. 

Table 26.) 



(Illustrating 



The Health of the Children 



35 



It will be seen that results vary widely. Death rates in 
the first group are only a little more than one-half what they 
are in the third. Among 6 societies (5 American and 1 Eng- 
lish), of 1,420 children bom there is reported an infant death 
rate of only 41. 

Are high death rates the result simply of certain soci- 
eties having older children or more children than others or 
the result of keeping them longer in China? 



A / 
/A 



j^ 



A. 



y;r-^?-cv„„rt?.-- 



, A / 

7 \ 



■"A 






/ 
/ 

/ 

J 



A 

/\ 

/ I, 
I A 



/J 



It 

V 



\ / \ 



V 






\ 



// 

./.* 



\ 



V 



Figure 12. Mortality of children compared with average age of chil- 
dren, average number of children per family, and percentage of time 
spent in China, by societies. (Illustrating parts of Tables 7, 15, and 26.) 



Figure 12 compares these factors graphically. None of 
the lines parallel the line expressing the total mortality. 
Though age of children may modify figures in certain cases, 
(e.g., we might say that the American Methodist and London 
missions have a low mortality in spite of having older chil- 
dren, and the Southern Baptist a high rate because of this 



36 The Health of Missionary Families in China 

factor) , yet age of children is not a predominant factor. The 
line representing the size of the families does rise fairly con- 
stantly with the mortality line. The percentage of time spent 
in China has little influence. One would not expect it to, for 
children are rarely sent home before seven years of age, by 
which time 88% of the deaths have occurred. It is the reverse, 
naturally enough, of the curve expressing, the average age of 
children, for the older the child the more time has he spent 
at school outside of China. 



Societies reporting less than 75 children each are put into five different 
groups, following national rather than denominational lines. The groups, 
with the societies in each, are as follows. The numbers refer to the number 
of families reporting: 

1. Other American Societies — Seventh Day Adventist, 31; Christian 
Missionary Alliance, 21; Reformed Church in America, 12; Methodist Epis- 
copal South, 11; United Evangelical Church Mission, 11; Foreign Church 
Mission Society, 10; Church of the Brethren, 10; Yale Mission, 9; China 
Mennonite Mission, 9; American Reformed Presbyterian, 8; China Medical 
Board, 6; other societies, 6; Canton Christian College, 5; Independent Mis- 
sions, 5; United Brethren in Christ, 5; American Advent Christian Mission, 4; 
American Bible Society, 3; American Free Methodist, 3; University of Nan- 
king, 1; Baptist College, Shanghai, 1; South Chihli Mission, 4; Assemblies 
of God, 4; Pentecostal Church of Nazarene, 4; Church of God, 3; National 
Holiness Mission, 3; Apostolic Faith Mission, 2; Seventh Day Baptist Mis- 
sion, 1; Methodist Protestant Mission, 1; American Friends Mission, 1; 
Ebenezer Mission, 1; Grace Mission, 1; Hebron Mission, 1; North Chihli 
Mission, 1; Tsehchowfu Mission, 1; China New Testament Mission, 1; Glad 
Tidings Mission, 1; Evangel Press, 1; South German, 2; Peniel Mission, 1. 

2. American Lutheran Societies— Norwegian Lutheran Church in Amer- 
ica, 27; Augustana Synod Mission, 10; Swedish American Mission, 7; Amer- 
ican Lutheran Brethren, 5; Lutheran Board of Missions, 5; Evangelical 
Lutheran Synod of Missouri, etc., 3. 

3. Other English Societies — Canadian Presbyterian, 19; Wesleyan Meth- 
odist Mission, 17; Christian Missions in Many Lands, 10; British and Foreign 
Bible Society, 10; English Presbyterian, 9; United Methodist Mission, 8; 
United Free Church of Scotland, 8; Church of England Mission, 7; Irish 
Presbyterian, 6; Friends Foreign Mission, 2; Salvation Army, 3; Canadian 
Church Mission, 2; Church of Scotland, 2; Miscellaneous, 2; National Bible 
Society, Scotland, 1; Canadian Holiness Mission, 1, 

4. European Societies Associated with China Inland Mission — Scandi- 
navian China All. Mission, 11; Swedish Mission in China, 10; Liebenzell Mis- 
sion, 5; German China All. Mission, 5; Swedish Holiness Mission, 5; Swedish 
Alliance Mission, 4; Norwegian Mission in China, 1; Norwegian Alliance 
Mission, 1. 

5. Other European Societies — Basel Mission Society, 15; Swedish Mis- 
sion Society, 12; Danish Lutheran Mission, 11; Norwegian Lutheran Mission, 
7; Norwegian Mission Society, 6; Berlin Mission Society, 5; Finland Mission- 
ary Society, 5; Swedish Baptist Mission, 4; Free Evangelical Mission of 
Norway, 1; Kiel China Mission, 1; Rhenish Mission Society, 1. 



The Health of the Children 



37 



Table 27 



MORTALITY OF CHILDREN 
IN SOCIETIES REPORTING BETWEEN 20 AND 75 CHILDREN 



SOCIETIES 



Am. Educational Institutiona.. 

Christian and Miss., All 

Am. Methodist, South 

Seventh Day Adventists 

Refonned Ch. in -Am 


53 
51 
46 
43 
43 


Foreign Christian Miss.* 

Lutheran United Miss 

Swed. Am.Miss.Cov 

Augustana Synod. 


99 
72 
20 
20 


Scandinavian All. Miss. 

Swedish MLss. in China 

Canadian Pres 


43 

34 
67 


Wesleyan Meth 


41 


Brit, and For. Bible Soc 

Ch. of Scotland... 


29 

27 


United Meth 


24 


Ch. Miss, in Many Lands 

Danish Luth. Soc... 


21 
34 




32 


Basel Miss 


29 



Total 
Birtha 



Number Dead 



Total 



0-5 
Years 



0-1 
Y'ear 



Number Dead Per 
1,000 Living Births 



Total 



109 
93 
23 

80 

in 

2,'iO 
50 
35 
176 
209 
146 
69 
185 

'233' 
324 
1S3 
103 



0-5 
Years 



57 
20 
109 
93 
23 
70 
83 
250 
50 
28 
176 
179 
122 
34 
74 

"23.S' 
324 
156 
i03 



0-1 
Year 



19 
20 

""76" 
23 
40 

'166" 
50 
14 
59 
104 
24 



143 

118 

63 





♦Facts concerning 36 children supplied by Dr. Illsgood not detailed enough to allow this society a seperate 

place in tables. 

In Table 27 is shown the data for societies reporting 
between 20 and 75 children. The numbers dealt with are too 
small to be of value, but the table is inserted for the benefit 
of those who may be interested. 

SOCIETIES IN RELATION TO LOCATION 

An important question now arises. Is the poor showing 
made by some of the societies due to geographical location^ 



Table 28 



PERCENTAGE OF CHILDREN LIVING IN SECTIONS OF CHINA 
BY SOCIETIES 





PERCENTAGE OF CHILDREN LIVING IN 


SOCIETY 


North China 
(Including Hon an) 


Central China 


South China 


Am. Bapt., North 


"32"" 
32 
32 
25 


63 
100 
39 
32 
51 
58 


36 


Am. Church MLs 




Am. Meth., North.. 


28 


London Mission 


36 


Y. M. C. A 


17 




17 






Total— 1st Group _ 


23 


56 


21 






Canadian Methodist 


"39" 
60 
67 
100 


100 
53 
38 
40 




Church Mis. Soc... . . 


47 


Am. Pres., North... 


22 


.Am. Luth. Societies - .... 




.Am. Board Mis 


33 


Ping. Baptist. _. 








Total— 2nd Group. 


43 


39 


17 






Other Eng. Soc. _ 


37 
36 

If 

77 


45 

61 
100 
29 
35 
23 


18 


China Inland Mis... ... 


3 






Other Europ. Soc 


27 


Am. Bapt., South 


14 


European C. I. M. . 








Total— 3rd Group 


40 


49 









Total All Societies 


35 


48 


15 



38 The Health of Missionary Families in China 

In Table 28 is shown the percentage of children reported 
from North, Central, and South China by each of the societies. 
In this and the following table Honan is included in North 
China. This is done to make the numbers more nearly even, 
and also because Honan 's mortality rate approaches the aver- 
age for North China more nearly than that for Central China. 

Table 28 shows that geographical location does have some 
effect on society mortality. In the first group (with lowest 
mortality), 21% of the children are in favored South China; 
in the second group, 17%, and in the third group, only 9%. 
This factor, of course, is only one of many, but it may help to 
explain the position of some of the societies in the table. For 
example, the English Baptist group might be higher up the 
list were not all the children in North China. American Bap- 
tist North and South might be nearer together did they not 
belie their names. The Southern Baptists have nearly a half 
of their children in North China, while the Northern Baptist 
have none of their workers in the north. 

Another question arises." Possibly the reverse of the fore- 
going assumption is true. Possibly the relatively high mor- 
tality rates from North China are due to the societies working 
there, and not to the unusual prevalence of disease. 

To answer this question, the mortality from North, Cen- 
tral, and South China for each society was calculated. 

Within each society we may expect to find mortality fairly 
constant, the geographical location being the variable which 
should modify results. Unfortunately, division into such small 
groups reduces the numbers below the point where great reli- 
ance can be placed on them. 



The Health of the Children 



39 



Table 29 MORTALITY OF CHILDREN BY SOCIETIES. AND BY SECTIONS OF CfflNA 



SOCIETY 


Section 


Total 
Number 
Living 
Births 


Number of Deaths 


Number of Deaths Per 
1,000 Living Births 




Total 


0-5 
Years 


0-1 
Year 


Total 


0-5 
Years 


0-1 
Year 


krtf- Rapt. , North 


North 

Central 

South 


'63" 
36 


"h' 

1 


""e" 

1 


.... 

1 


"95" 

28 


'95" 
28 


63' 




28 


Am. Meth., North 


North 

Central 

South 


66 
74 
67 


8 
5 
3 


7 
5 
3 


3 
3 
1 


121 
68 
53 


106 
68 
S3 


45 
41 




18 


London Mission 


North 

Central 

South 


26 
26 
30 


1 

4 
2 


1 
3 
1 



2 
1 


38 
154 
67 


38 
115 
33 




77 




33 


Y.M. C.A 


North 

Central 

South 


38 
61 
21 


4 

8 



4 

7 



2 
6 



105 

131 




105 

115 




53 
98 







Ch. Misa. Soc... 


North 

Central 

South 


"so" 

44 


"Y 

4 


""7" 
4 


""3" 
4 


140" 
91 


.. . 
140 
91 




60 




91 


Am. Pres., North 


North 

Central 

South 


124 
122 
68 


14 
15 
9 


10 
12 

7 


5 
4 
5 


113 
123 
132 


80 
98 
104 


40 
33 




75 


Am. Board 


North 

Central 

South 


92 
"46" 


17 
""§" 


14 
.... 


5 
.... 


185 
"65" 


152 
"22' 


54 




22 


Other Am. Soc 


North 

Central 

South 


110 

254 

74 


21 

23 

6 


14 

18 
6 


6 
8 
4 


199 
91 
81 


127 
71 
81 


55 
32 




54 


km. Luth. Societies-. 


North 

Central 

South 


82 
55 


7 
11 


6 
9 


2 
3 


85 
200 


73 
164 


24 
54 






Other Eng. Soc. 


North 

Central 

South 


141 
93 
56 


27 
13 
2 


23 
9 
2 


15 
3 
1 


191 
140 
36 


163 
97 
36 


106 
32 




19 


Other European Soc. . 


North 

Central 

South 


75 
49 
47 


24 
6 
4 


21 
5 
4 


12 
4 


320 
123 
85 


240 
102 
85 


160 
82 






European C.I. M 


North 

Central 

South 


109 
32 


17 
5 


17 

5 


8 
2 


156 
156 


156 
156 


74 
62 






China Inland Mbsion .. 


North 

Central 

South 


164 

272 
12 


41 
39 


31 
26 


17 
15 


255 
143 


189 
96 


104 
54 






Am. Bapt., South 


North 

Central 

South 


61 
41 

17 


13 
9 
5 


9 
8 
4 


5 
5 
3 


213 
219 
299 


144 
195 
235 


82 
122 




176 



In nine of the fourteen societies mortality rates decreased 
progressively from north to south. In four, on the other 
hand, they increased. In one (the Y. M. C. A.) Central China 
showed higher rates than either North or South China. 



40 The Health of Missionary Families in China 

From this analysis we can conclude that geographical 
location in itself helps to determine mortality, but that it is 
not the only factor in determining the death rates for societies. 
It should be remembered that many societies in North China, 
particularly in Shensi, Manchuria and Mongolia, are doing 
difficult pioneer work. In all frontier communities, death 
rates among children are high. 

In later tables further light will be thrown on the cause 
for the high rates in North China. 



Table 30 



SIZE OF SOCIETIES 

MORTALITY OF CHILDREN 
WITH REFERENCE TO SIZE OF MISSIONARY SOCIETIES 



Societies Reporting 
Following Number 


Number 

of Living 

Births 


Number of Deaths 


Number of Deaths Per 
1 000 Living Births 


of Children 


Total 


0-5 
Years 


0-1 
Year 


Total 


0-5 
Years 


0-1 
Year 


More than 75 (13 societies) 

Between 20 and 75 (20 societies) 
Less than 20 (60 societies) 


2,028 
753 
418 


275 
104 
67 


220 
86 
55 


121 
37 
34 


135 
138 
160 


108 
114 
131 


60 
50 
81 




Figure 13. Mortality 
of children by size 
of missionary soci- 
eties. (Illustrating 
Table 30.) 



As seen in Table 30 and Figure 13, there 
is little difference in death rates for soci- 
eties reporting between 20 and 75 children, 
and those reporting over 75. The rates are 
increased, however, for the 60 small soci- 
eties reporting less than 20 children apiece. 

NATIONALITY OF SOCIETIES 

In Table 31 and Figure 14 is shown the 
mortality according to the country in which 
the head office of the society is located. 
"Great Britain" includes Ireland, Scotland 
and Australia. The China Inland Mission 
is classed separately, as it has offices in 
various countries. "Europe" includes the 
European missions associated with the 
China Inland Mission. 



The Health of the Children 



41 



Table 31 



MORTALITY OF CHILDREN BY NATIONALITY OF SOCIETIES 



MISSION OFFICE 


Number 

of Livinc 

Births 


Percent- 
ase of 
Total 


Number of Deaths 


Number of Deaths Per 
1,000 Living Births 


LOCATED IN 


Total 


0-5 
Years 


0-1 
Year 


Totel 


0-5 
Years 


0-1 
Year 


America 


1,732 

4no 

209 
449 


55 
15 
6 
14 


216 
60 
29 
80 


173 
51 
26 
57 


90 
28 
15 
32 


122 
122 
139 
178 


97 
104 
124 
129 


51 
57 


Canada — 

(Ciiina Inland) 


72 
71 


Total outside Europe — 


2,930 


90 


385 


307 


165 


131 


105 


56 


Europe 


310 


10 


66 


59 


31 


213 


190 


100 




Figure 14. Mortality of children by uatioualicy of mission- 
ary societies. (Illustrating Table 31.) 



Table 32 



BIRTHPLACE OF PARENTS 

MORTALITY OF CHILDREN, BY BIRTHPLACE OF PARENTS 



PARENTS BORN 


Total 
Number 
Births 


Number of Deaths 


Number of Deaths Per 
1,000 Living Births 




Total 


Under 5 
Years 


Under I 
Year 


Total 


Under 5 
Years 


Under 1 
Year 


1. One -r both born in China.. 

2. Both born in United States 

3. Father and motlier born in 


176 
701 

311 

491 
218 


16 

84 

40 

71 

46 


12 

72 

31 

58 
39 


8 
37 

13 

31 
19 


100 
120 

129 

141 
212 


68 
100 

100 

118 
180 


45 
63 

42 


J 4. Both bom in Great Britain 

1 or Colonies 

5. Both born in Europe. 


63 
87 


Total 


1,897 


257 


205 


108 


125 


108 


67 




1,307 


191 


1,58 


88 


147 


121 


63 







42 The Health of Missionary Families in China 




Figure 15. Mortality of children by birthplace 
of parents. (Illustrating Table 32.) 



Table 32 and Figure 15 show the mortality of children 
according to the birthplace of parents. The group with the 
lowest mortality is the one in which one or both parents were 
bom in China. Is this because of acquired resistance to dis- 
ease, or because of better knowledge of the means of pre- 
vention ? 

In this table, again, children of continental European 
parentage show the highest mortality. This tabulation is 
incomplete, because in two-fifths of the questionnaires the 
birthplace of parents was not stated. Children of parents who 
did not fill the blanks in detail show a higher death rate than 
children of those who did. This would seem to show that 
those who are most interested in an investigation of this sort 
are also more successful in preventing sickness and death 
among their children. 



The Health of the Children 



43 



MEDICAL TRAINING OF PARENTS 

Investigators agree that an important factor in child mor- 
tality is the intelligence of parents concerning medical mat- 
ters. If in this study, children of doctors and nurses have a 
lower mortality than others, it will be an argument for more 
extensive education of missionaries in matters of health. If, 
on the other hand, they do not show a distinctly lower mor- 
tality, not much can be hoped for from this quarter. Table 33 
and Figure 16 show the results of this tabulation. 



Table 33 



MORTALTTY OF CHILDREN BY MEDICAL TRAINING OF PARENTS 





Total 
Number 
Living 
Births 


Number of Deaths 


Number of Deaths Per 
1,000 Living Births 




Total 


0-5 
Years 


0-1 
Year 


Total 


0-5 
Years 


0-1 
Year 




379 
252 
146 


47 
23 
11 


42 
21 

8 


25 
14 
4 


124 
91 
75 


111 

83 
54 


65 


Mother a doctor or nurse 

Both parents medically trained 


65 
27 


Total.- -- 


777 


81 


71 


43 


104 


91 


56 






Neither parent medically trsiaed 


2,427 


367 


292 


153 


151 


120 


63 




Figure 16. Mortality of children by medical 
training of parents. (Illustrating Table 33.) 

The education of the mother seems to have greater influ- 
ence than that of the father, though results are best when both 
are trained. This would indicate that home sanitation is of 
more importance than medical treatment. It would point the 
particular value, also, of education of the wife in hygiene and 
the elements of preventive medicine. Note that infant mor- 
tality differs but little between the trained and untrained. 



44 The Health of Missionary Families in China 

The big difference comes after the first year. Families in 
which both parents have training show the remarkably low 
infant mortality rate of 27. 

In this tabulation only those parents who have had at least three-fourths 
of medical or nursing training are included among the trained. Thoee with 
partial training were too small a class to make calculation of the mortality 
rate of value. 



Table 34 



MORTALITY OF CHILDREN BY MEDICAL TRAINING OF PARENTS 
AND BY SECTIONS OF CHINA 





Total 

Number 

Born 


Number of Deaths 


Number of Deaths Per 
1,000 Livini? Births 


SECTION 


Total 


Under 5 
Years 


Under 1 
Year 


Total 


Under 5 
Years 


Under! 
Year 


PARENTS WITH MEDICAL 

TRAINING 
North... 


209 
425 
134 


24 
49 
10 


20 
44 

8 


9 
27 

7 


115 
115 

75 


95 
103 
59 


43 




64 


South.. . 


52 






Total with Training 

PARENTS WITHOUT MEDI- 
CAL TRAINING 
North 


768 

743 

1,315 

372 


83 

154 
180 
32 


72 

122 
141 

28 


43 

65 
71 

17 


lOS 

205 
137 
86 


93 

162 
107 
75 


56 
86 




64 


South. 


45 






Total without Training. 


2,436 


366 


291 


153 


149 


119 


62 




Figure 17. Mortality of children by medical training of 
parents and by sections of China. (Illustrating Table 34.) 



The Health of the Children 



45 



This good showing of the trained does not mean that the 
doctors and nurses are concentrated in South China. Twenty- 
six per cent of their children are in North China, against 30 
per cent of the children of those without training. 

Table 34 and Figure 17 show that for each section of 
China the children of the medically trained have a lower mor- 
tality. (One exception is the high infant mortality among the 
trained of Central China.) The matter of medical training 
is not, however, the only factor, for the trained in North China 
have a higher rate than the untrained in South China. 



Tablets 



MORTALITY OF CHILDREN BY MEDICAL TRAINING OF PARENTS AND 
BY GROUPS OF SOCIETIES 





Total 
Number 
of Living 

Births 


Number of Deaths 


Number of Deaths Per 
1,000 Living Births 


SOCIETIES 


Total 


0-5 

Years 


0-1 

Year 


Total 


0-5 
Years 


0-1 

Year 


PARENTS WITH MEDICAL 
TRAINING 


273 
237 
267 


21 
26 
34 


20 
24 
27 


10 
14 
19 


76 
109 
127 


73 
101 
101 


36 




59 


Third Group 


71 






Tota! with Training ...- 


777 


81 


71 


43 


104 


91 


56 


PARENTS WITHOUT MEDI- 
CAL TRAINING 


777 

678 

1,008 


80 
92 
199 


63 
74 
158 


36 
33 

S4 


115 
1,35 
197 


81 
109 
156 


46 




48 


Third Group 


83 






Total without Training- 


2,463 


371 


295 


153 


150 


119 


61 



The good showing of the medically trained is in spite of 
the fact that doctors more than missionaries in other types of 
work have been used in pioneer work, located in inland sta- 
tions where mortality rates would naturally be high. The 
same is not necessarily true of wives who are doctors or 
nurses (this may be one reason for the lower rates of these 
families in contrast with the families in which the husband is 
a doctor), but medically trained wives are usually called on 
for heavy work outside the home. 



46 The Health of Missionary Families in China 




Figure 18. Mortality of children by medical training of 
parents and by groups of societies. (Illustrating Table 35.) 



In Table 35 and Figure 18 the figures are reclassified 
into groups of societies. Here the same result is obtained. 
The trained in each group make a better showing than the 
untrained (except for the infants of the middle group), but 
the untrained of the first group have a lower rate than the 
trained of the third group. (For the societies comprising 
each group, see Table 26.) 

RATIO OF DOCTORS TO THE MISSION FORCE 

A corollary of the preceding discussion is the question of 
the ratio of doctors to the missionary force. Table 36 gives 
the percentage of doctors among the 25 largest societies. The 
figures do not include children. The issue is not clear-cut, 
for certain societies, e.g., the Y. M. C. A., are in cities where 
community or doctors of other missions are available. In 
the table the order of societies follows the order of total mor- 
tality of children, those with the lowest at the top. Five of 
the seven lower societies (71%) have less than the average 
percentage of doctors, while only three of the nine upper soci- 
eties (33%) have less than the average percentage (6.1%). 



The Health of the Children 



M 



The ratio given in the table for some of the English and Cana- 
dian societies is abnormally low because of the enlistment of 
some of their doctors in the war. 

It would be of interest to know what percentage of sta^ 
tions are without doctors, also how many foreigners each mis- 
sion doctor has dependent on him. 



Table 36 



PERCENTAGE OF PHYSICIANS TO THE TOTAL ADULT MISSIONARY 
FORCE BY SOCIETIES 



SOCIETIES* 


Total Foreign Force 
(Adult) 


Number Physicians 
(Men and Women) 


Percentage of 
Physicians 




138 


14 


10.3 






American Church Misaiona . 


204 


12 


5.8 






American Methodist, North ..... 


363 


22 


6.1 








149 


16 


10.7 






Y. M.C. A. 


175 












467 


13 


2.8 






Canadian Methodist 


178 


13 


7.3 






Church Missionary Society .. 


316 


20 


6.6 








467 


49 


10.5 








77 


3 


4. 








166 


8 


4.8 






Other English Societies . . . 


319 


66 


2.1 








940 


13 


1.3 








142 


16 


11.2 






Other European Societies .. .. 


184 


5 


2.7 








153 


11 


7.1 






Total - 


4,436 


273 


6.1 







♦Figures are taken from the China Mission Year Book (1918) and include only the 25 largest societies. 



RECENT AND REMOTE PERIODS 

We look to the future. We are not particularly concerned 
about death rates of several decades ago. It is pertinent to 
inquire, therefore, (1) what proportion of the children of this 
study belong to recent times; (2) whether death rates of chil- 
dren have been decreasing at equal pace with the decrease in 
rates in England and America. 

In order to answer these questions, all blanks were tabu- 
lated with respect to the number of years parents have been 
married. 

Only a few reports were received concerning families not 
now on the field, so that practically all the subjects of this 



48 The Health of Missionary Families in China 



study are the children of missionaries who are now active 
missionaries. Of the 3,126 children, whose parents' years 
of marriage are recorded, the parents of 31% were married 
less than 10 years ago, 70% less than 20 years ago, and 92% 
less than 30 years ago. Of the 2,623 living children, whose 
ages are recorded, only 51% are more than 9 years old, 15% 
more than 19 years, and 3% more than 29 years (Table 16). 
The average age of all children is 8.6 years. This study, then, 
deals in the main v/ith a recent period of missionary work. 

Table 37 gives the mortality for four periods. A source 
of error should be noted. Classification is based on the num- 
ber of years married, rather than on the number of years ago 
married. In the cases in which a parent had died, the children 
are counted as born more recently than they were born. This 
error would tend to increase rates slightly for the more recent 
periods. In Table 38 only the 0-1 and 0-5 year groups are of 
value. Deaths after five years of age are naturally increased 
in the older families because the children are older. 



Table 37 



MORTALITY OF CHILDREN BY LENGTH OF TIME PARENTS HAVE 
BEEN MARRIED 



Number of 


Total 
Living 
Births 


Number of Deaths 


Number of Deaths Per 
1,000 Living Births 


Tears Wliich 
Pareats Have 
Been Married 


Total 


0-5 

Years 


0-1 
Year 


Total 


p-5 
Years 


0-1 
Year 


0-9 


9S6 

1,219 

672 

249 

89 


92 
151 
132 

58 
8 


90 
129 
100 

34 
7 


4S 
76 
47 
14 
6 


93 
123 

182 

233 

90 


91 

106 
149 
136 

79 


49 


10-19 


62 


l(>-29 


70 


80 and oyer 

Years not stated 


56 
67 



If we divide the children into two groups, the first group 
comprising those whose parents have been married less than 
20 years, the second group those whose parents have been 
married more than 20 years, and if we count the deaths for 
the first group by adding the number of children at present 
living, but who will die before completing the first or the fifth 
year, we get the following figures : Infant mortality, first 
group 58, second group 66. Mortality under 5 years, first 
group 120, second group 145. This means a reduction of mor- 
tality between the two groups {i.e., in the 10-15 years which 
separates the two) of 12% in infant mortality and 18% in 
mortality under five years. 

Because of the round-about method of arriving at the 
above figures, comparison with government statistics must 
be far from accurate. 



The Health of the Children 



49 



Between the years 1900 and 1911 infant mortality in the 
United States" was reduced 22%, and mortality under five 
years 27%. In England,^^ during the 40-year period ending; 
1911-15, mortality was reduced as follows : for the first year 
of life, about 30% ; for the second year, a little over 40% ; for 
the third, fourth, and fifth years, about 50%. 



Table 38 



MORTALITY AMONG FIRST AND SECOND BORN CHILDREN BY NUMBER 
OF YEASS PARENTS HAVE BEEN MARRIED 



Number 


Number 

of Living 

Births 


Number of Deaths 


Number of Deaths Per 
1,000 Living Births 


of Years 
Married 


Total 


0-5 
Years 


0-1 
Year 


Total 


0-5 
Years 


0-1 
Year 


0-9 


815 
679 
313 
106 


79 
94 
70 
27 


77 
76 
45 
13 


38 
47 
21 
10 


97 
138 
227 
225 


94 
112 
144 
169 


47 


10-19 


69 


20-29 


67 


30 or more 


94 



In Table 38, as illustrated in Figure 
19, only first and second births in each 
marriage period are counted. In this 
way the births are more sharply con- 
fined within the various periods. The 
difference in mortality for the 0-1 and 
0-5 age periods of these first and sec- 
ond-born children is greater than 
when all children are counted. The 
difference is due largely to the very 
low mortality of third and later bom 
children among those married more 
than 30 years. These 143 children 
show an infant mortality of only 21. 
Is this a case of survival of the fittest 
or of acquired immunity? 

In Table 38 mortality of children of 
the first group (parents married less 
than 20 years) show, for infants, 25%, 
and for children under five, 32% improvement over the second 
group (parents married more than 20 years). These figures 
would be slightly less if corrected for the first and second 
bom living children under five and one who will die before 
reaching those ages. 




Figure 19. Mortality of 
first and second born 
children by number of 
years parents have 
been married. (Illus- 
trating Table 38.) 



50 The Health of Missionary Families in China 

The study of this phase shows that there has been a reduc- 
tion of child mortality among missionary children in recent 
years. It is doubtful, however, if this is greater than the 
reduction which has taken place among the general population 
of civilized countries during the same period. Probably the 
reduction would be greater if we had figures for children of 
the entire previous generation of missionaries. The families 
now on the field have demonstrated their abilitv to survive. 



Table 39 



ORDER OF BIRTH 

MORTALITY OF CHILDREN BY ORDER OF BIRTH 



Ordw 


Total 
Number 
of Livina 

Births 


Number of Deaths 


Number of Deaths Per 
1,000 Living Births 


of Birth 


Total 


0-5 
Yean 


0-1 
Year 


Tctal 


0-5 
Years 


0-1 
Year 


lat bom 
and " 
3rd " 
4th " 
5th " 
6th and more. - 


1,122 
854 
569 
340 
17S 
152 


158 
117 
72 
42 
22 
30 


130 
90 
62 
32 
19 
27 


70 
49 
30 
20 
10 
12 


141 
137 
127 
124 
123 
197 


115 
105 
108 
94 

100 
177 


62 
57 
53 
58 
56 
79 


Total 


3,215 


441 


360 


191 


137 


112 


59 




In Table 39 and Figure 20 
is sho\sTi the mortality of 
children by the order of birth. 
There is a slight do^vnward 
tendency of all age groups 
until after the fifth child, 
when all rates leap upward. 
This rise is due entirely to 
increase in deaths among 
children under 5 years. The 
cause for this, in part at 
least, is shown in Figure 28, 
second column. 



figure 20. Mortality of children by 
order of birth. (Illustrating Ta- 
ble 39.) 



The Health of the Children 



51 



NUMBER OF CHILDREN IN FAMILY 

Table 40 MORTALITY OF CHILDREN BY NUMBER OF CHILDREN IN FAMILY 



Number of 

Children 


Total 

Number of 

Living 

Births 


Number of Deaths 


Number of Deaths Per 
1,000 Living Births 


in Family 


Total 


0-5 
Years 


0-1 
Year 


Total 


0-5 
Years 


0-1 
Year 


1 


264 

380 

689 

625 

490 

252 

74 

72 

63 

62 


20 
50 
96 
99 
66 
51 
21 
11 
18 
18 


19 
40 
80 
81 
48 
45 
16 
8 
15 


18 
19 
41 
42 
27 
23 
10 
4 
6 


75 
132 
139 
158 
135 
202 
284 
153 
286 
290 


70 
105 
116 
130 

98 
179 
216 
111 
233 
226 


60 


2 

8 


50 
60 


4.. 


67 


5 . 


55 


6 


93 


7 


135 


8.. . . 


56 


9 


95 


10.11.12 


14 6 


97 


Total 


3,229 


450 


66 194 


139 


113 


60 




Figure 21. Mortality of children by num- 
ber of children in the family. (Illus- 
trating Table 40.) 



Table 40 and Figure 
21 show mortality ac- 
cording to the size of 
the family. Infant mor- 
tality remains fairly 
constant until families 
having more than five 
children are reached. 
Mortality of other chil- 
dren, however, increases 
progressively, as the 
family increases in size. 
A curious fact is the 
relatively low mortality 
in families where there 
are five children. 

The increase of rate 
for large families is due 
in part to the fact that 
the children are older. 



52 The Health of Missionary Families in China 



Table 41 



BIRTHPLACE OF CHILDREN 

MORTALITY OF CHILDREN BY BIRTHPLACE 





Number 

of Living 

Births 


Number of Deaths 


Number of Deaths Per 
1,000 Livinj; Births 


BIRTHPLACE 


Total 


0-5 
Years 


0-1 
Year 


Total 


0-5 
Years 


0-1 
Year 


Outside of China 


385 


49 


40 


20 


128 


104 


52 


In China 


2,819* 


399 


325 


174 


141 


115 


62 



^Includes a few children whose place of birth was not stated. 




Figure 22. Mortality of 

children by birthplace. 

(Illustrating Table 41.) 



Among missionaries one often hears 
discussions concerning the relative 
health of children born in China and 
those born at home. Table 41 shows that 
there is no great difference of mortality 
in the two groups. The advantage for 
those bom outside China is 14% for the 
first year and 10% for the rest of life. 
Children born outside China have spent 
58% of their life in China, while all chil- 
dren have spent 67%. 

The following is the list of birthplaces of chil- 
dren born outside of China: United States, 191; 
England and Wales, 53; Canada, 28; Scotland, 15; 
Sweden, 12; Australia and New Zealand, 11; Ger- 
many, 10; Norway and Finland, 6; Ireland, ;'. ; 
miscellaneous, 56; total, 385. Percentage of chil- 
dren born in China, 87.5; percentage of married 
life spent in China, 81.0. 



OTHER FACTORS OF CHILD MORTALITY 

It was realized that the more questions asked in the ques- 
tionnaire, the fewer would be the answers. Therefore, sev- 
eral important factors not included in the statistical study 
should be mentioned. 

Salaries — As a rule, curves of child mortality closely par- 
allel the curves representing family income, i.e., the lower the 
wages, the higher the number of deaths. It is likely that 
where missionary salaries are insufficient to provide summer 
vacations, the best milk available, medical overhauling on fur- 
lough, etc., deaths will result. Though exact information has 
not been obtained, the writer thinks that the average salary 
paid by societies in the lower half of Table 26 is less than that 



The Health of the Children 53 

paid by societies in the upper half. One parent in the former 
group writes, '^How can I bring up and educate my children 
on a salary of (the equivalent of) G $400 a year?" However, 
such a cry was found in the letters but rarely. Information 
as to whether there is waste of life and efficiency because of 
sub-living salaries would be hard to secure from the mission- 
aries directly. 

Amahs. ''The environment of the infant," says Sir George 
Newman,^^ "is its mother." "The problem of infant mor- 
tality is not one of sanitation alone, of housing, or indeed of 
poverty as such, but is mainly a question of motherhood."^* 
Another says, "The most important factors in infant mortal- 
ity are the strength, the health, the character and the intelli- 
gence of the mother. "-° An extremely pertinent question is, 
"What is the effect on child mortality in China of the substi- 
tution of hired nursehood for motherhood, of the substitution 
of the 'health, the character and the intelligence' of a Chi- 
nese servant woman for the 'health, the character and the 
intelligence' of the missionary mother? If children are deliv- 
ered entirely into the keeping of servant Chinese, we cannot 
expect a mortality a great deal lower than that for the Chinese 
children, as shown in Figure 1. 

There is naturally a wide difference of opinion as to how 
much the personal care of children should be subordinated to 
the prosecution of mission work. One mother takes her small 
children with her on country trips purely as a bait for attract- 
ing crowds. Though these statistics do not permit analysis of 
the part care and feeding of the children by amahs plays in 
child mortality, a number of the correspondents deal with the 
point and make it clear that they consider it an important fac- 
tor in mortality of missionary children in China. 

Kitchens — A third of all deaths of these children were 
due to intestinal infections ; dysentery, diarrhoea, cholera, and 
tjrphoid fever. This points to the enormous importance of the 
kitchen in the life, or death, of missionary children. Many 
kitchens in North China are dark, dirty, and fly-infested, used 
by all the servants, the government an absolute monarchy 
with the native cook on the throne ; in short, a favorable port 
of embarkation for all germs bound intestineward. 

The importance of breast-feeding and medical care have 
been mentioned. Other factors which can be only named are : 
milk and water supply, location in the city or country, method 
of sewage disposal, summer vacations, location of schools, etc. 



54 The Health of Missionary Families in China 



THE CAUSE OF DEATH, BY GROUPS OF DISEASES 

Besides knowing the proportion of children dying, it is 
important from the side of prevention that we know the causes 
of death. For purposes of comparison, all causes of deaths 
are divided into ten groups. By this means we diminish the 
error from using small numbers and from inexact diagnoses. 

The groups used are as follows: (1) dysentery ("with blood and 
mucus" specified on question blank), both acute and chronic. (2) Intestinal 
infections aside from dysentery and typhoid fever, Including diarrhcea, colitis, 
cholera infantum, Asiatic cholera, enteritis. (3) Respiratory infections — 
bronchitis, pneumonia, and whooping cough. (4) Smallpox. (5) Six 
major infections, viz., diphtheria, scarlet fever, typhoid fever, tuberculosis, 
malaria and meningitis. (6) Birth defect and injury, difficult labor, 
eclampsia, malformation, etc. (7) Prematurity. (8) Malnutrition, difficult 
feeding. (9) All other causes, and (10) cause unknown, not stated or unin- 
telligibly stated. 



Table 42 



GEOGRAPHICAL LOCATION 

MORTALITY FROM VARIOUS DISEASES BY SECTIONS OF CHINA 





Total 


Number of Deaths Per 1,000 Living Births From Specified Causes 






a 






□ 


u, 






Z 


1 
5 


SECTION OF CHINA 


Number 










o 


° 






■3 




Li\'ing 
Births 


t 


J3 
g 


S 


g 


S „ 


8 


£ 

3 




o 


03 

O 






























3 


fc 


& 




O o 


:S"c 


a 


^ 


o 


a 






h 


Q 


^ 


a 

CO 


■& 


H 


(X, 


S 


< 


6 


North 


95S 

1,740 

506 


32 
21 
9 


19 
17 

1 


22 
14 

1 


9 
6 


38 
25 
19 


8 
7 
5 


7 
5 
3 


5 
4 

7 


29 
19 
16 


11 


Central 


10 


South 


7 








Figure 23. Mortality of children from various causes by sections 
of China. (Illustrating Table 42.) 



Tables 42-49 give the number of deaths for all ages per 
1,000 children born. Table 42 and Figure 23 show why death 
rates decrease from North China to South China. Every 
disease group with the single exception of ''malnutrition" 



The Health of the Children 55 

shows this downward curve. The sharpness of the descent is 
most marked for the intestinal, respiratory and smallpox 
groups, and less marked for the major infectious group. 

The figures show strikingly the disproportionate impor- 
tance of infections over constitutional causes of death in North 
China. If we add the first five groups embracing the infec- 
tious (bacterial) diseases, and take the ratio for North China 
as the index, Central China shows 39% and South China 
only 14% of the deaths which North China records. Now if 
we combine the next three groups — which gives the deaths for 
nutritional, developmental and birth causes — we find that 
Central China has 80% and South China 75% of the rate for 
North China. 

In other words, as a cause of death these non-infectious 
conditions are, in relation to North China as a standard, two 
times more important in Central China and five times more 
important in South China than the infectious diseases. 

MISSIONARY SOCIETIES 

Some of the external factors which influence mortality 
rates in societies (i. e., age of children, number in family, per- 
centage of time in China, geographical distribution of work- 
ers, proportion of doctors) have been considered. Other even 
more important factors are internal to the societies, having 
to do with the policy of the boards towards the selection of 
workers and subsequent care of them. There is no attempt 
in this paper to relate mortality rates of individual societies 
to these internal factors. This can be done best by members 
of the various societies. 

It is important, however, that this study help show soci- 
eties from what quarters death has come in the past. This is 
attempted in Table 43. Division of the statistics into so many 
groups diminishes the reliability of results, soi that only 
marked differences from the average should attract attention. 



56 The Health of Missionary Families in China 



Table 43 MORTALITY OF CHILDREN FROM VARIOUS CAUSES, BY SOCIETIES 





Total 

Number 

of Living 

Births 


Number of Deaths Per 1,000 Living Births From Specified Causes 


SOCIETY 


1 


"o 

t 

3 


1 
1 


a 

1 


J 


o 

h 

pa 


1 


1 

"3 


1 
o 

& 
■S 
o 

< 


1 
S 
CO 

o 

1 
o 


Am. Bapt., North_ 


99 


10 


10 


20 




20 


10 




















78 


26 


13 






13 








13 


13 
















Am. Meth., North 


197 


20 


5 


15 


5 


10 




10 




15 






82 




12 






12 








60 


















Y. M. C. A. 


120 


17 


17 


8 




8 


8 


17 


25 














437 


16 


9 


18 


7 


25 


2 


7 


2 


16 


9 








1,013 


16 


10 


14 


4 


18 


3 


7 


4 


16 


5 






Canadian Meth 


134 


30 


7 


15 




7 


7 


7 


7 


15 


15 




94 




11 


21 




32 


11 






32 


11 










Am. Presb., North 


314 


22 


6 


9 


6 


18 


6 


9 


6 


26 


6 




137 


21 


7 


7 


21 


14 








14 


42 














13S 


43 


7 


7 




36 






7 


36 


7 












98 


20 


20 


20 




20 


20 


20 




20 


20 








915 


24 


8 


12 


5 


20 


6 


6 


4 


24 


15 






Other Eng. Sec 


291 


34 


7 


10 


7 


31 


7 


7 




34 




China Inland Mis 


449 


22 


9 


22 


4 


40 


4 


4 


7 


29 


22 


Am. Presb., South. 


106 




56 


19 




56 


28 


9 




9 


9 


Other European Soo 


171 


40 


18 


29 


18 


23 




6 


6 


40 


12 


Am. Baptist, South 


119 


25 


33 


8 




75 


17 




17 


42 


17 


European C. I. M _ 


139 


43 


72 


14 


22 


43 








29 


7 


1 










Total — 3rd group 


1,275 


28 


26 


18 


6 


40 


5 


4 


4 


31 12 


All Societies - 


3,203 


23 


15 


15 


6 


28 


5 


6 


4 


24 11 






1 



The Health of the Children 



57 




Figure 24. Mortality of children from various causes by societies. 
The societies are in the order of total mortality, as in Figures 
11 and 12. (Illustrating Table 43.) 



Table 43 gives the deaths from various causes by soci- 
eties. Figure 24 shows the relative number of deaths from 
four of the groups of diseases. Here, as in Table 42, the 
striking difference is between the infectious and constitutional 
causes. Societies which are near the bottom of the list are 
there because of the six major and the intestinal infectious 
diseases. There is little difference between the first and third 
groups of societies in respiratory infections, and practically 
no difference in the deaths connected with birth and nutrition. 
Three of the society groups show relatively twice as many 
deaths from smallpox as all other societies combined. 



58 The Health of Missionary Families in China 



NATIONALITY OF SOCIETIES 

Table 44 MORTALITY OF CHILDREN FROM VARIOUS CAUSES BY NATIONALITY 

OF MISSIONARY SOCIETIES 





Total 


Number of Deaths Per 1,000 Births From Specified Causes 






C3 














3 


-o 


SOCIETIES WITH 


Number 












o 






3 


a 


•HEAD OFFICES IN 


of Living 




o 


>> 




■g 


o 




o 


o 


CQ 


- 


Births 


>> 


S 


g 


M a 


?^b 


s 


'S 


l~> 


o 
































fc 


A 




o 


5'a 


a 


a 


o 








Q 


■q 


fS 


a 

CO 


s 


m 


£ 


S 


^ 






1,662 
776 


21 
21 


14 
9 


13 
11 


5 

2 


27 
20 


6 

8 


5 
1 


5 

1 


19 

28 


1 


Great Britain and Canada. 


6 


(China Inland) 


449 
310 


22 
42 


9 
42 


22 
22 


4 
19 


40 
32 


4 


4 
3 


7 
3 


29 
35 


22 




10 








Figure 25. Mortality of children from various causes by nationality of 
missionary societies. (Illustrating part of Table 44.) 



Table 44 and Figure 25 show the causes of deaths by 
nationality of societies. American and English (including 
colonial) societies show no significant differences in causes 
of death. The China Inland group (which is mostly English 
and American) shows an increase in respiratory and major 
infections. The European societies (which include those asso- 
ciated with the C. I. M.) show greatest increase in the intes- 
tinal infections, in smallpox, and in miscellaneous causes. 



The Health of the Children 



59 



BIRTHPLACE OF PARENTS 

Table 45 MORTALITY OF CHILDREN FROM VARIOUS CAUSES BY BIRTHPLACE OF PARENTS 





Total 


Number of Deaths Per 1,000 Births From Specified Causes 






a 








^ 






^ 


TJ 


BIRTHPLACE 
OF PARENTS 


Number 
of Living 




-a 
O 


>. 




a 






S 


3 
OS 

O 


5 




Births 


5 


"S 


g 


_o 


Q& 


3 


•E 


te 


o 










.t! 






3 














g 


s 


a. 




^ 2 


"5 a 


a 


s 


o 


3 






>> 

Q 


i3 




1 


CO 


CP 


£ 


2 


< 




One or both born in China . . 


176 


28 


5 


11 




39 


11 


5 




17 




Both born in Europe 


218 


50 


22 


36 


32 


36 


4 


4 




36 


18 


All others where both stated 


1,503 


18 


18 


15 


5 


28 


8 • 


6 


4 


15 


6 


Total al' societies 


3,203 


23 


15 


15 


6 


28 


5 


6 


4 


24 


11 



Table 45 is deficient because for more than one-half of 
the children the birthplace of parents was not recorded. Un- 
fortunately for the accuracy of the computation, the number 
of children with a parent bom in China is small. These chil- 
dren have no deaths from smallpox or malnutrition, and rela- 
tively few from diarrhoea. 

Of all the children whose parents were bom in Europe 
5% have died of dysentery and more than 3% of smallpox. 
Of the children who have died, 15% have died of smallpox. 



MEDICAL TRAINING OF PARENTS 

Table 4ft MORTALITY OF CHILDREN FROM VARIOUS CAUSES BY MEDICAL 

TRAINING OF PARENTS 





Total 
Number 
of Living 

Births 


Number Deaths Per 1,000 Living Births From Specified Causes 


MEDICAL TRAINING 
OF PARENTS 


1 

3 

Q 


a 
"o 
O 

i 

5 


>> 

1 


o. 

"a 

a 


a 

o a 
"3.2 

■r 


11 


"a 


a 
.2 

1 


i 

o 

1 

o 
< 


s 

"o 
CO 


Father a doctor 


379 
252 
146 


24 
16 
27 


19 
12 

7 


19 
12 




21 

8 
7 


10 
16 

7 






21 
12 
20 


10 


Mother a doctor or nurse... 


...... 


8 

7 


12 










Total ... . 


777 


22 


14 


13 




14 


11 


1 


4 


18 


8 






Neither parent medically 
trained.. 


2,463 


23 


16 


16 


8 


32 


7 


7 


5 


23 


11 







60 The Health of Missionary Families in China 




Figure 26. Mortality of children from various causes by medical 
training of parents. (Illustrating part of Table 46.) 



We turn with interest to the cause of death among the 
medically trained, shown in Table 46 and Figure 26. As be- 
tween father and mother who are trained, we are prepared to 
find as we do, that intestinal infections are less in the families 
in which the trained mother has charge of the kitchen. Even 
more marked, however, is the reduction in deaths from major 
infections. Presumably this is not because the doctor-wife or 
nurse-wife is better in curing disease, but because she is more 
successful in preventing infection. 

Comparing the last two lines of the table we see that the 
children of the medically trained have suffered less than the 
untrained from the major (mostly air-borne) infections and 
less from pre-maturity (presumably because of better pre- 
natal care). No children of this class have died of smallpox. 

It is disappointing to find that children of the trained die 
from intestinal infections almost as frequently as children of 
the untrained. 

RECENT AND REMOTE PERIODS 

Table 47 MORTALITY OF CHILDREN FROM VARIOUS CAUSES BY NUMBER OF 

YEARS PARENTS HAVE BEEN MARRIED 







Number of Deaths Per 1,000 Living Births From specified Causes 


NUMBER OF YEARS 


Total 




c« 








ll 






i 

3 


-o 


PARENTS HAVE 
BEEN MARRIED 


Number 
of Living 


b 


9 








£ 


•1 


6 


CD 




Births 


-g 


^ 


^ 


D. 


's.2 


Q'a 


rt 


3 


•Z 






g 


t 


o. 


03 


s s 


■s-^ 


a 




o 


§ 






Q 


5 


« 


CC 


■^'" 


^^ 


£ 


:s 


< 




0-9 


986 


21 


8 


8 


3 


14 


9 


8 


5 


10 


5 


10-19 


1,209 


2T 


16 


16 


7 


23 


9 


5 


5 


16 


11 


20-29 


672 


27 


25 


27 


12 


50 


6 


6 


1 


36 


9 


30plua.- 


249 


32 


28 


16 


4 


44 






28 


60 


32 











The Health of the Children 



61 




Figure 27. Mortality of children from various causes by number of 
years parents have been married. (Illustrating part of Table 47.) 



In Table 47, all groups, except those associated with birth, 
show diminished deaths for families married the shortest 
length of time. As this is for deaths at all ages, naturally 
the younger families have had fewer deaths. The percentage 
reduction from the highest to lowest rate is 60%. Dysentery 
has shown less than the average reduction (34%). Deaths 
connected with birth have increased in the younger families 
rather than diminished. All other groups show a large reduc- 
tion in the younger families of from 70% to 87%. 



ORDER OF BIRTH 

Table 48 MORTALITY OF CHILDREN FROM VARIOUS CAUSES BY ORDER OF BIRTH 





Total 


Number of Deaths Per 1,000 Living Births From Specified Causes 






C8 








-o 






S 


•o 


ORDER OF BIRTH 


No. Living 












m 






I 


« 




Births 




% 


1 


o 


o a 
"S ° 


ll 


3 


.2 


o 
'S. 


CO 

o 






a 




.tj 








c« 


3 












S3 


& 


ca 


^ s 


■2'a 


S 




o 


3 






Q 


(3 


u 

tf 


^ 


CO 


m 


fi 


S 


< 






1,122 
854 
569 
518 
151 


25 
25 
33 
15 
20 


12 
21 
19 
6 
33 


14 
13 
12 
23 
26 


2 
5 
9 
6 
33 


27 
38 
21 
29 
20 


10 
3 
9 

8 
7 


10 
4 

2 

7 


4 
3 
3 

8 
7 


20 
25 
14 
25 
59 


11 


2nd born. - 


8 


3rd born . . 


10 


4th and 5th born,.. 


10 


Born Gth or later. 


13 



62 The Health of Missionary Families in China 



*° 
















0. 








1 


1 




ll 


1 


■ 


1 


-■■■■ 


lull 


BORN 


t3T|2 »b|5jo|4-5J6 + 


IJT 2«I!|i*o|4-5|6«- 


1 ST Izwolssoj* 5^1 6t- 


1 iTJ2«D|jno|4-5|6» 


CAU2£ 
OF oeATd 


DIARRHEA, • ETC- 


iMALL POX 


SIX MAJOR 
lU FECTION3 


fREMATURt BIRTH 
MftCT- MAlHOTRinOII 



Figure 28. Mortality of children from various causes by order 
of birth. (Illustrating part of Table 48.) 



Table 39 showed a gradual reduction in deaths among 
children through the fifth bom. In looking for the cause of 
this reduction, in Table 48 we find that the premature group 
is the only one shomng a steady decline, but that the diarrhoea 
and major infections group show fewer deaths among the 
third to fifth born than among the first and second bom. 
Parents learn somewhat with experience how to guard against 
these infections. 

What is the cause of the sudden rise in rates for the sixth 
or later born children? There are only 151 of this group. The 
rise is almost entirely due to four groups, %"iz., miscellaneous 
causes, smallpox, diarrhoea, and respiratory infections. Small- 
pox causes six times the number of deaths in these later bom 
children that it causes in the first to fifth born. Can it be that 
parents with six or more children find the task of providing 
protective vaccination for the last born children too burden- 
some? 

Dysentery and major infections, be it noted, diminish in 
power over the last bom. Is this because of better preventive 
measures learned through experience, or because of acquired 
resistance? 



The Health of the Children 



63 



NUMBER OF CHILDREN IN FAMILY 

Table 49 MORTALITY OF CHILDREN FROM VARIOUS CAUSES BY NUMBER OF 

CHILDREN IN FAMILY 





Total 


Number of Deaths Per 1,000 Living Births From Specified Causes 


NUMBER OF 




2 








a 






S 


"S 


CHILDREN 


Number 




"o 






, 








3 


a 


IN FAMILY 


of Living 




1 


>. 




a 






s 




CQ 




Births 


a 


1 

o. 


1 

a 


■rt.a 
^1 




£ 

3 

a 


1 


O 


o 






Q 


Q 


Pi 


t/2 


M 


03 


PL, 


»a 


-< 


o 


1 _ 


264 
380 
6S9 
625 
490 
523 


11 

18 
27 
24 
20 
38 


4 

8 
16 
19 
16 
29 






4 
18 
36 
35 

24 

48 


4 
16 

6 
10 

6 

8 


19 
3 
7 
6 


...... 

4 

13 
2 
6 


11 

16 
22 
22 
35 
29 


24 


2 


26 
14 
14 
16 
23 


8 
1 
6 
2 
21 


5 


3... 


7 


4 


6 


5 


14 


6 or more- 


19 



.1 



II. 



I 



m mnr ra 



J 4 5 £H 



D Y 5 t N T £ ^V 



DIARR-HEA CHOLe.R.A 



MAJOR. INftCT10N5 



HLKVTKl riON 



Figure 29. Mortality of children from various causes by number of 
children in families. (Illustrating part of Table 49.) 

Table 40 showed a three-fold increase in total deaths for 
the families with six or more children over the families with 
one child. In Table 49 and Figure 29 we see that this increase 
is due to the principal infectious diseases. Deaths from dys- 
entery increased 3.6 times, diarrhoea 7 times, major infections 
12 times, and smallpox (average of first five groups) nearly 
7 times. On the other hand, deaths from respiratory infec- 
tions, birth, malnutrition, etc., have not increased with the 
increasing size of the family. 

This means that quarantine within the family, especially 
for the air-borne infections, has been at fault. Deaths from 
dysentery and diarrhoea have been twice the average increase, 
but deaths from the group of diphtheria, scarlet fever, mala- 
ria, tuberculosis, meningitis and typhoid have been four times 
the average. This is in spite of the fact that deaths from 
these infections among later born children are less than 
among earlier born. Study of individual reports shows infec- 



64 The Health of Missionary Families in China 

tions, once started, run through families as they would not in 
communities where isolation and quarantine are strictly 
enforced. 

CAUSES OF DEATH BY INDIVIDUAL DISEASES 

Table 50 gives the number dying from these various dis- 
eases, and the ages at death. Figure 30 shows the percentage 
of the total deaths, in which a cause was given, due to the 
various diseases or groups of diseases. Dysentery alone has 
caused nearly a fifth of the deaths. Dysentery together with 
the acute intestinal infections (diarrhoea, enteritis, cholera, 
etc.) have caused nearly a third of the total. 

Sixty-nine per cent of the deaths from dysentery and 
81% of those from diarrhoea occurred during the first two 
years of life. 



Table 50 



CAUSES OF DEATHS OF CHILDREN WITH AGE AT TIME OF DEATH 





Total 
All 

Ages 


Number of Deaths at Ages Specified 


DISEASE 


MONTHS 


YEARS 




0-1 


1-2 


3-5 


6-11 


0-1 


1 


2 


3 


4 


5 


-10 


-20 


N.S. 




77 


1 




( 


19 


26 


27 


11 


6 


3 


4 


















47 


1 


3 


6 


11 


21 


17 


4 


1 




1 


2 




1 








51 


2 


2 


5 


12 


21 


14 


10 


2 





3 


1 














24 






2 





2 


7 


6 





3 


6 






















19 


2 


1 


4 


3 


10 





3 





4 


2 
















Meningitis 


17 






2 


3 


5 


4 


2 


1 




2 


1 


2 












Scarlet Fever . . 


16 












1 


1 


1 


4 


9 


























Typhoid Fever . 


12 








1 


1 


3 


1 


1 


1 


3 




2 
















10 








2 


2 


1 


3 


2 





2 
























10 








2 


2 


2 


1 






1 


2 


2 




















20 


2 





2 


3 


7 


3 


3 





1 


4 


2 














19 


18 





1 





19 






































10 


9 


1 






10 








































Birth Defect 


12 


6 





1 


3 


10 


1 


1 






























14 


2 


1 


4 


4 


11 


2 


1 






























5 


3 


1 


1 




5 






































17 


1 





3 


4 


8 






2 





3 


3 


1 














9 






1 




1 


2 





1 


1 




2 


2 












War_. 


11 






















4 


6 


1 




























44 


20 


2 


3 


8 


33 


3 


1 


--- 


2 


1 


2 


2 








Total--- 


444 


67 


11 


41 


75 


194 


87 


48 


17 


19 


41 


19 


17 


2 



*Age not stated. 



The Health of the Children 



65 



CAUM Of OtATH 



PERCENT Of BEATHS 




} hhhhhhhT^riy^ 



OVitHTERY 



REiPIRATOR'T 



RIHTM OErtCTS 
^ INJURIES 



rtlSCELLANEOUi 
INFECTIONS 



WAX 4 AlCCIOENT 



mSCEU-ANEDOl 
CONOniONk 



f^ALNOTUlTION 



iCAHLET PEVER 



TYPHOID FEVER 



TUBERCULOil!, 



Figure 30. Percentage of deaths of children from various causes. 
(Derived from Table 50.) 



In the table "diarrhoea" includes all cases of acute intestinal infection 
other than dysentery and typhoid fever. Seven cases were listed as cholera. 

"Respiratory" includes, besides pneumonia, six cases of bronchitis and 
six of whooping cough. Of the children dying of whooping cough, five were 
aged one year or under, one was five years old. 

"Diphtheria" includes three cases listed as tonsilitis. 

"Other Infections" include fever three, appendicitis three, vaccination 
two, erysipelas two, measles two, and one each of liver abscess, typhus fever, 
sore throat, influenza, sprue, kalaazar, infantile paralysis, and blood poisoning. 

"Miscellaneous" includes heart trouble three, nephritis two, hardship 
two, and one each of intersusception, spinal disease, diabetes, jaundice, cir- 
cumcision, poisoning, sunstroke, sewage gas, myxedema, and seasickness. 

"Accident" includes three killed by bandits, two by drowning, one suffo- 
cated by quinine pill. 

"Premature" births were, in one case each, said to be due to eclampsia, 
dysentery, malaria, and quinine. 

Three of the ten deaths from tuberculosis were due to tuberculous 
meningitis. 



66 The Health of Missionary Families in China 



Table 51 



PERCENTAGE OF DEATHS OCCURRING AT SPECIFIED AGES, DUE TO VARIOUS 
CAUSES, COMPARED WITH UNITED STATES AND ENGLAND 



CAUSE OF DEATH 


Missionary 
Children 


United States 

1918 

(Native White Parents) 


England and Wales 
1917 




0-1 
Year 


Under 
5 Years 


5-9 
Years 


0-1 
Year 


Under 
5 Years 


5-9 

Years 


0-1 
Year 


Under 
5 Years 


^9 
Years 


Typhoid Fever. . _ 


.6 


2.1 


7.5 


.03 


.16 


2.7 


.001 


.01 


.4 






Malaria 


1.3 


2.5 


5. 


.09 


.15 


2.7 
















Smallpox.. 


6 3 


5.2 


5. 


.01 


.02 


.04 
















Measles. . 


1.2 


.8 




1.3 


2.9 


3.4 


2.8 


8.9 


7.5 






Scarlet Fever. . 




2.1 


22.5 


.08 


.55 


3.3 


.05 


.4 


1.8 








Diphtheria and Croup 


1.3 


5.6 


10.5 


.5 


3. 


13.7 


.2 


2.2 


13.8 


Dysentery. 


16. 


23. 


10. 


.4 


.6 


.5 


.01 


.01 


.03 






Tuberculosis 


1.3 


1.5 


2.5 


1.5 


2.7 


7.4 


2.9 


6.1 


22. 






Syphilis . 








1.2 


.9 


2 


2.1 


1.4 


.06 












Meningitis. __ . 


3.1 


4. 


5. 


.8 


1.3 


2.7 


1.4 


2. 


4.4 






Bronchitis, Pneumonia and 
Whooping Cough 


13.3 


14. 


7.5 


16.6 


18.8 


9.9 


23.4 


26.8 


13.2 


Cholera, Diarrhea, Enteritis 


13.5 


13.5 


2.5 


23.1 


22.2 




10.7 


8.9 


2. 


Premature Birth 


11.3 


5.5 




20.4 


14.4 




19.9 


12.2 








Injury at Birth 


6. 


2.4 




4.1 


2.8 




1.2 


.7 








Total 


75.2 


82.4 


78. 


70.1 


70.5 


46.5 


64.6 


09.6 


65.1 






All other causes 


24.8 


17.8 


22. 


29.9 


29.5 


53.5 


35.4 


30.4 


34.9 







Table 51 compares the principal causes of death among 
missionary children, the white population of America,** and 
the general population of England and Wales."^ The figures 
are the percentage of the total deaths for the ages specified. 

It should be noted that diagnoses given by parents are oftentimes inac- 
curate, as their idea of the doctor's diagnosis may be in error, or there may 
have been no doctor in attendance. In government statistics, on the other 
hand, diagnoses are nearly always made by the physician in attendance. For 
this reason, no emphasis is laid on any but the well marked differences in 
Table 51. Again, the figures, being percentages of the total number of deaths 
for the various ages, would total 100 for each age group. Other diseases not 
named in the table (mainly those classed under "other fevers" and "miscel- 
laneous") would show higher percentages for England and America than for 
missionaries. In the table, percentages for respiratory infections, prematur- 
ity, measles, tuberculosis, and syphilis are lower among missionary children 
than among children in England and America. 



The Health of the Children 



67 




Figure 31. Percentage of deaths under one year of age from various causes 

among Missionary Children and children in the United States and 

England. (Illustrating part of Table 51.) 



The most significant differences are shown in the three 
following charts. Figure 31 gives the deaths under one year. 
Three points stand out: (1) The high black tower represent- 
ing deaths from dysentery, 40 times higher than the corre- 
sponding column for England and Wales, and 1,600 times that 
for the United States. (2) The black gravestone standing 
over smallpox — a monument to lives needlessly sacrificed. 
(3) A death rate from prematurity only one-half the standard 
(for which the absence of venereal disease may largely ac- 
count), but a death rate from obstetrical disasters of twice 
the standard — probably the result of insufficient medical 
attention. 



68 The Health of Missionary Families in China 




Figure 32. Percentage of deaths under five years of age from various causes 

among Missionary Children and children in the United States and 

England. (Illustrating part of Table 51.) 



The deaths under five years from dysentery (Figure 32) 
show an even higher proportion of the total (23%). Small- 
pox shows a rate 260 times that for the United States and 
infinitely above England, as that country had no deaths at 
these ages from smallpox in 1917. 

The comparative infrequency among missionary children 
of deaths from respiratory infections is striking for all three 
age groups. The relative immunity of adults to influenza 
during the pandemic of 1917 is noted elsewhere (p. 91). 



The Health of the Children 



69 



OEATMb 5-9 YEARb 
MlbblONARX CMILDRtN CH\N/\ 



N UNITED STATES [wMlTEi] 
^ ENC^LAND if WALES 




Figure 33. Percentage of deaths five to nine years of age from various causes 

among Missionary Children and children in the United States and 

England. (Illustrating part of Table 51.) 

As there are only 40 deaths of children aged 5-9 recorded, 
Figure 33 has not as great value as the other charts. Besides 
the persistently prominent position of dysentery and small- 
pox, the figure shows the comparative deadliness of scarlet 
fever at this age. Typhoid fever is given as cause of death 
in 7.5% of the cases. This points the need of typhoid inocu- 
lation for children of this age. 



Table 52 



DEATHS OUTSIDE CHINA 

CAUSES OF DEATHS OCCURRING OUTSIDE OF CHINA 



CAUSE OF DEATH 


Number 


Ages at Death 


SOCIETIES 


Infantile Paralysis 

Dysentery 

Diarrhea. 


1 

2 
3 
1 

2 
3 
1 

2 

1 
2 
1 
1 
1 
2 
1 
2 

1 
10 


3 days 
1.2 
1 
2 

1.4 
4, 8, 21 
19 

19,21 
4 mo. 
10 mo., 26 
6 
4 
2 
5 mo., 8 mo. 
6 days 
14, 15 
8 mo. 
18, 19 (3) 
20, 21 (2) 
23, 25, 26 


Swed. All. Miss. 

Swed. Miss. Soc, Danish Lutheran. 

Y. M. C. A., Baptist No., Pres. South. 


Pneumonia 

Whooping Cough 

Typhoid Fever.. . 


Yale. 

Presbyterian, South (2) 

Baptist, South. (3) 




American Lutheran. 


Tuberculosis 


Other English. 




Other English. 


Meningitis .. 


Swed. Miss., Bapt., South. 


Scarlet Fever.. 


European C. I. M. 


Appendicitis 

Septic Sore Throat 


Other English. 
American Board. 
Y. M. C. A. (2) 


Premature 


C. I. M. 




Other American, Pres. No. 


"Seasickness". 


Other European. 


Killed in War 


London Miss. (2); Other English (2). 




Eng. Bapt., C. I. M. (5) 


Total 


37 











70 The Health of Missionary Families in China 

Thirty-seven deaths are recorded as occurring outside of 
China, This is 8.2% of the total number of deaths. Of these, 
five children died on board ship going to or from China. Two 
others died while in Korea and Japan. So that only Q.Q% of 
the deaths occurred while children were in the homeland. If 
the deaths from war are excluded, this leaves only 19, or 4.4% 
of the total deaths. About 33% of the children's life was spent 
at home. As only 6.6% of the deaths occurred there, there are 
about five chances of the child dying in China to one of his 
dying in the homeland. It must be remembered, however, 
that most of the "homeland" years were those of later child- 
hood, when mortality is lower than in early life. 

Sometimes missionaries are accused of a lack of patriot- 
ism. Eleven children of English missionaries died in the war, 
one of disease, and ten killed in battle. In the four societies 
represented, one-third of the children who have died, aged 
five years and over, have died while in the service of their 
country. 

MORBIDITY AMONG CHILDREN 

So far this study has been concerned with the deaths of 
children. Many sicknesses, however, do not result in death, 
and yet prevent robust health. 

The statistics concerning morbidity are not so reliable as those con- 
cerning mortality. Sicknesses not resulting in death are more likely to be 
forgotten. Furthermore, for malaria, dysentery, bronchitis, worms, tonsilitis, 
the report was often "many times," "occasionally," "not often," etc., in which 
cases the illness in question was recorded but once. Though the total ill- 
nesses are certainly well above the 5,744 here recorded, the figures are of 
value for comparative purposes within the group. In order to make the 
comparison as accurate as possible, the sicknesses reported are reduced to the 
number per 1,000 years of residence. The tables concerning morbidity and 
general health are based on the histories of 3,036 children only. This gives 
an average of 1.9 illnesses per child. 



The Health of the Children 



71 



Table 53 ABSOLUTE NUMBER OF CASES OF PRINCIPAL INFECTIONS AND NUMBER PER 1000 
YEARS OF RESIDENCE BY PROVINCES. 



SICKNF.SS 


.2 
1 


to 

1 




1 

03 


d 

CO 


1 


3 

a 


-a 
a 
< 


a 
a 

'■% 




a 
a 
W 


M 


1 


& 



-a 

1 

tS 

a 

3 

w 


a 

3 


a 
1 


a 




Total Years of- Residence 




3S1 


1527 


1448 


569 


593 


470 


2359 


651 


1083 


1263 


476 


1069 


850 


1672 


886 


1321 








Number of Sicknesses per 1000 Years of 


Residence 






Total per 1000 yrs.. 


300 


245 


216 


348 


200 


257 


301 


203 


263 


254 


247 


214 


306 


203 


184 


226 


Dysentery __ 


60 
21 
18 
12 

.3 

3 


24 
13 
10 
10 
5 
8 


41 

9 
15 

7 

9 

5 
0.7 
13 

5 
12 
10 
30 

7 
21 
21 

9 


69 
17 
12 

"9' 
19 
4 
21 
4 
10 
26 
45 
10 
35 
52 
14 


32 
23 
11 
11 
2 
12 


15 
6 
6 
6 
2 

17 


42 
9 
9 

12 
8 
2 


18 
7 

12 
6 

""3' 
6 

"is' 

6 

47 
16 
24 
26 

1 


21 

7 
12 

6 

6 

4 

.9 

7 

3 
39 
11 
32 
11 
39 
56 

9 


58 
5 
4 
7 

10 

2 

..... 

3 
14 

5 
51 
11 
30 
32 
16 


50 

6 

8 

4 

2 

2 

2 

8 

2 

38 

6 

39 

21 

29 

21 

8 


23 
12 
12 
9 

..... 

4 
4 
10 
23 
8 
33 
13 
14 
24 
11 


43 
16 
17 
11 

8 

"'8 
6 
4 

13 
8 

63 
6 

47 

43 
2 


23 

8 
10 

9 
1.8 

5 

1 
11 

2 
19 

2 
47 

7 
16 
26 
12 


16 
10 
6 
7 
6 
7 
.... 

33' 
4 

31 
4 

13 

30 

14 


28 




g 


Bronchitis 


g 


Pneumonia... 


5 


Diphtheria 


5 


Smallpox. 


1 


Meningitis 


7 




30 
3 
12 
21 
42 
12 
27 
21 
12 


24 

6 

5 

7 

32 

18 

26 

31 

22 


17 
11 
13 

"28" 

7 

20 

13 

8 


34 

"I' 
61 
25 
21 
42 
4 


13 
7 
35 
6 
47 
16 
36 
35 
15 


2 


Typhoid Fever 

Malaria 


2 
35 


Influenza 


5 


Measles 


19 


Mumps. . 


13 


Chicken Pox 

Whooping Cough 

Tonsilitis 


38 
37 
15 










Nui 


tfBER OF Si 


3KNES 


JES 








Total Sicknesses 


99 


373 


313 


198 


119 


121 


712 


136 


284 


320 


118 


229 


260 


340 


163 


299 


Dysentery 


20 

7 
6 
4 

1 
1 


37 
21 
15 
15 
7 
13 


59 
14 
21 
11 
14 
7 
1 
20 
7 
17 
15 
44 
10 
30 
30 
13 


39 
9 
7 
4 
5 

11 
2 

12 
2 
6 

15 

26 
6 

20 

30 
8 


19 
14 
6 
7 
1 
2 

""9' 
7 
8 

"17" 
4 
12 
8 
5 


7 
3 
3 
5 

1 

8 

1 

16 

"2" 
31 
12 
10 
20 
2 


101 
22 
22 
29 
19 
4 
4 
31 
16 
81 
14 

111 
50 
86 
83 
36 


12 
5 

88 
4 

"2 
4 

12' 

4 
31 
11 
16 
17 

7 


23 

8 

13 

7 

6 

4 

1 

8 

3 

42 

11 

35 

11 

42 

60 

10 


66 
7 
6 
8 

13 
3 

""16' 
4 

18 
7 
65 
14 
38 
41 
20 


24 
3 
4 
2 
1 
1 
1 
4 
1 
17 
3 

19 
10 
14 
10 
4 


25 
14 
13 
10 

..... 

4 
4 
11 
26 
9 
36 
14 
16 
27 
12 


37 
14 
15 

9 

3 

'3" 

5 

4 
11 

7 
54 

6 
38 
37 
16 


38 
13 
17 
16 
2 
8 
2 

19 
4 
32 
4 
80 
13 
28 
44 
20 


14 
9 
5 
6 
5 
6 
.... 

'29" 
4 
28 
4 
12 
27 
13 


37 


Diarrhea, etc... . _ . 


13 


Bronchitis.. 


11 


Pneumonia 


g 


Diphtheria . . .. 


g 


Smallpox 


2 


Meningitis 


1 


Scarlet Fever 

Typhoid Fever 


10 
1 
4 
7 

14 
4 
9 
7 
4 


37 
9 
8 
10 
48 
28 
39 
50 
35 


3 
3 




46 


Influenza .. 


7 


Measles .. 


26 




18 


Chicken Pox 


51 


Whooping Cough 

Tonsihtis.. 


49 
20 



Table 53 shows both the relative and the absolute number 
of the principal sicknesses for each of the provinces. It will 
be observed that the provinces with the largest number of 
illnesses are not, necessarily, the ones with the highest mor- 
tality, i.e., those with the highest absolute number of cases, 
may not have the highest percentage of cases. For instance, 
Kiangsu reports 101 cases of dysentery — half again the num- 
ber of the next highest province. But it stands only sixth in 
the number of cases in relation to the number of years spent 
in China. The density of the missionary population in the 



72 The Health of Misslonnry Fdnillies in China 

Ymigise valley gives that section the reputation of an unduly 
hii!:h dysentery rate, which reputation, so tar as the children 
are concerned, is undeserved. 





y //^m'ancnur'ia* j 


p/^ /::::?::•/ 


^rf^ ' 'cHiHu * ' I*/ y' 'y 


Y'. % : '\\ \'y 


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Figure o4. Number of cases of dysentery per 1,000 years of residence among 
children by provinces (from Table oo). Number of dots represents num- 
ber of cases per 1,000 years" residence per unit square of surface, e.g., 100 
square miles. The figures indicate simply the number of cases per 1,000 
years of residence. Absence of boundary lines between provinces indi- 
cates that data from these provinces lu-e combined. 



The distribution of dysentery shown in Figure 34 is of 
interest. Provinces reporting most dysentery per 1,000 yeai^ 



The Health of the Children 



73 



are: Shansi, 69; Manchuria, 60; Honan, 58. A wide gap sep- 
arates these from the provinces reporting least, viz.: Che- 
kiang, 11; Kansu, 15; Fukien, 16. 

Shansi and Kansu have the distinction of reporting the 
most cases of smallpox. Kansu, Manchuria, Shantung and 
Shansi have far more scarlet fever than the other provinces. 
Chekiang, Kiangsi, Kiangsu and Kwangtung report the most 
malaria. Of the total sicknesses tabulated, Shansi reports the 
most, P^ukien the fewest. 

Round worms are not classified in the table. Various 
provinces reported infection per 1,000 years as follows: 
Fukien, 41.7; Hunan and Kweichow, 40.4; Kwangtung, 33.3; 
Hupeh, 29; Chekiang, 26; Kiangsu, 25.8; Honan, 23; Shan- 
tung, 21; Szechuan, 20; Cliihli, 13.1. Definite sickness from 
round worms was named but once (jaundice, with death); 
13.4% of the children were reported as having had round 
worms. 

The chief diseases for the sections are shown in Figure 35. 

Besides the sicknesses listed in the table, the following are reported, 
the number beinjj too small to make division into provinces of value: Round 
worms, 402; hook worm, 12; pin worm, 31; operation, tonsil or adenoid, 157; 
mastoid, 4; hernia, 9; difficult feeding, 90; malnutrition, 29; heart disease, 
24; tuberculosis, 23; appendicitis, not operated 11, operated 23; rheumatism, 
19; rickets, 13; trachoma, 13; kidney disease, 8; relapsing fever, 5; cholera, 
5; tapeworm, 4; St. Vitus dance, 4; cyclic vomiting, 3; erysipelas, 3; men- 
tally defective, 3; kalaazar, 1; infantile paralysis, 2; miscellaneous, 14; 



total, 812. 
Table 54 



NUMBER OF PRINCIPAL INFECTIONS BY SECTIONS OF CHINA, AND OCCURRING 
OUTSIDE OF CHINA. 





North 


Central 


South All 
China 


Outside 
China 




SICKNESS 


Number ok Years of Residence 


Province or 
Years of Residence 
Not Stated 


4940 


9436 


2227 


16,573 


8748 




Nci 


IBER OF Cases of Specified Sick 


VE88 




TOTAL 


1227 


2425 


462 


4,114 


708 


110 






Dysentery 


181 
68 
59 
46 
29 
42 
4 

104 
26 
43 
49 

180 
64 

120 

145 
66 


326 

85 

98 

85 

44 

28 

17 

85 

43 

242 

59 

462 

129 

278 

319 

125 


51 

22 

16 

12 

11 

8 

1 

4 

3 

75 

11 

54 

22 

63 

76 

33 


558 

175 

173 

143 

84 

78 

22 

193 

72 

362 

119 

696 

215 

461 

540 

225 


14 
12 
6 
17 
12 
...... 

38 

10 

9 

3 

232 

68 

91 

171 

19 


23 




e, 


Bronchitis 


7 


Pneumonia ... 


f, 


Diphtheria 


2 


Smallpox 


5 


Meningitis 





Scarlet Fever 


7 


Typhoid Fever 


5 


Malaria 


11 


Influenza . 





Meaales 


3 


Mumps .. 


11 


Chicken Pox ... 


8 


Whooping Cough 


11 


Tonsifitis 


5 







74 The Health of Missionary Families in China 

Table 54 gives the total number of sicknesses by sections, 
together with the sicknesses contracted outside of China. 

Diseases contracted outside of China not named in Table 54 are the 
following: Infantile paralysis, 6; malnutrition, 2; appendicitis, 6; rheuma- 
tism, 3; heart trouble, 1; kidney, 1; tuberculosis, 1; round worms, 1; pin 
worms, 2; erysipelas, 1; total, 24. 

The only disease which is not the more common in China 
is infantile paralysis ; two cases were reported from China, as 
against six reported from outside China. 



Table 55 



NUMBER OF PRINCIPAL INFECTIONS PER 1000 YEARS OF RESIDENCE, BY 
SECTIONS OF CHINA AND OCCURRING OUTSIDE OF CHINA. 





Number or Cases per 1000 Years op Residence 


SICKNESS 


OccDRRiNO IN China 


Occurring Outside 
OF China 




North 
China 


Central 
China 


South 
China 


All 
China 




TOTAL 


248 


257 


209 


249 


81 






Dysentery .. .- 


37 
13 
12 
11 

6 

9 

.8 
21 

5 

9 

10 
36 
13 
24 
29 
13 


34 

9 

13 

9 

5 

3 

2 

9 

5 

25 

16 

49 

14 

28 

33 

13 


23 

9 

7 

5 

5 

4 
.4 

2 

1 
33 

5 
24 

9 
28 
34 
25 


34 
11 

9 

8 

5 

5 

1.4 
12 

4 
22 

7 
42 
13 
28 
33 
14 


1.6 




1.4 




.6 




2. 




1.4 


Smallpox 




Meningitis _ -_--. 


.5 




4.3 




1.1 


Malaria.. _........ 


1.0 




.4 




26.6 


Mumps 


7.0 




10.0 




19.9 


Tonsilitis . ......... 


2. 








Figure 35. Number of infections of various diseases per 1,000 years' residence' 
by sections of China. (Illustrating part of Table 55.) 



The Health of the Children 



7S 



Table 55 gives the sicknesses of Table 54 expressed in 
number of sicknesses per 1,000 years of residence. Central 
China has a slightly higher morbidity than North China, due 
to excess of malaria and measles. South China exceeds other 
sections only in the amount of malaria, tonsilitis and whoop- 
ing cough. Its total rate would be higher if cases of round 
worms and all cases of malaria were included. Figure 35 
illustrates a portion of Table 55. 




Figure 36. Number of cases per 1,000 years' residence of various dis- 
eases contracted in China and outside of China. (Illustrating 
part of Table 55.) 



Figure 36 shows the comparative number of sicknesses 
contracted in China and outside of China. The highly con- 
tagious children's diseases, scarlet fever, measles, mumps, 
chicken pox, and whooping cough, are contracted while the 
children are home more frequently than the other diseases. 
The comparatively low rate of sickness of children while at 
home is to be accounted for in part by the fact that children 
are home for school during the later years when they are less 
susceptible to the serious infections. 

PERCENTAGE OF MORTALITY 

We have seen that more children die in the north than in 
the south. This is partly because more serious diseases are 
prevalent in the north. But it is also (Table 56 and Figure 
37) due to the fact that, for practically all the diseases, the 



76 The Health of Missionary Families in China 

north shows a higher percentage of mortality than the south. 
This may be because of greater virulence of the disease, or 
because of less provision for medical care. It is not because 
children in the north are less robust. (See Table 61.) 



Table 56 



PERCENTAGE OF MORTALITY FOR VARIOUS DISEASES, BY SECTIONS 



DISEASE 


North 


Central 


South 


All China 




12.1 

20.8 

3.3 

28.2 

34.3 

28.5 

75.0 

12.5 

17.2 

46.5 

0.5 

1.4 


10.4 

26.7 

2.0 

17.7 

25.0 

35.7 

58.8 

2.3 

9.3 

0.8 


7.8 
4.5 

"io"o" 


10.0 




21.7 




2.2 




20.2 




25.0 




28.1 




63.6 




7.7 




12.5 




2.2 




0.1 




0.37 








Figure 37. Percentage of mortality for various diseases by sec- 
tions of China. (Illustrating part of Table 56.) 



MAJOR AND MINOR INFECTIONS 

Because of the evident importance of the infections, vari- 
ous infectious diseases are divided, in Tables 57-58, into two 
classes, and comparison made among provinces and societies 
as to the number of cases per 1,000 years of life. 

The major infections include dysentery, diarrhoea, cholera, etc., pneu- 
monia, tuberculosis, meningitis, typhoid fever, scarlet fever, smallpox, 
typhus, cholera, malaria, and infantile paralysis. Minor infections include 
measles, mumps, chicken pox, bronchitis, intestinal worms, etc. Infections 
contracted both in China and at home are counted. 



The Health of the Children 



77 



GEOGRAPHICAL LOCATION 

Table 57 NUMBER OF INFECTIONS OF CHILDREN BY PROVINCES 


PROVINCE 


No. OF Infections 


Number of Infections per 
1000 Years of Life 




Major 


Minor 


Major 


Minor 




53 
191 
147 

99 
104 

55 


56 
307 
258 
137 
75 
94 


83. 

61. 

78. 
128. 
130. 

85. 


94. 


Shantung,. . _. 


134. 


Chihli. 


124. 


Shansi-.. . . 


161. 


Shensi 


96. 


Kansu 


145. 






North! 


649 


927 


83. 


128. 






Kiangsu ..... 


376 
54 

144 

129 
50 

121 
79 
23 

172 


622 
114 
250 
299 

S3 
172 
188 

27 
288 


116. 

62. 
106. 

67. 

81. 

75. 

83. 
125. 

61. 


192. 




131. 


Honan _ . .. 


184. 


Chekiang ... 


156. 


Kiangsi 


134. 


Hupeh 


107. 


Hunan . ... 


200. 


Kweichow 


156. 


Szechuan . 


102. 






Central 


1148 


2043 


84. 


149, 






Fukien. 


91 
171 

8 


252 
342 

8 


61. 
77. 
85. 


170. 


Kwangtung 


154. 
85. 






South 


270 


602 


71. 


159. 






All China.. 


2067 


3572 


81, 


144. 







The major infections are equally frequent in North and 
Central China, but less frequent in South China. The minor 
infections, on the other hand, increase from north to south. 
(This tabulation includes intestinal parasites.) 



Table 58 



MISSIONARY SOCIETIES 

NUMBER OF INFECTIONS OF CHILDREN BY SOCIETIES 



SOCIETY 


Number of Infections per 1000 Years 




Major 


Minor 


English Baptist 


123. 
113. 
103. 

93. 

89. 

84. 

84. 

81. 

80. 

79. 

75. 

70. 

70. 

67. 

62. 

58. 

56. 


163. 


American Church Mission . . 


261. 


Scandinavian Societies. . 


102. 


Y.M.C.A.... 


294. 


American Baptist, South 


115. 


American Lutheran Societies . 


172. 


American Board.,, 


135. 


Other English Societies... . . . 


117. 


Cand. Methodist . . . 


145. 


Other Am. Soc- 


159. 


Am. Methcdist, No 


163. 


German and Swiss . 


56. 


Am. Bapt., North 


117. 


China Inland 


122. 


Church Mis. Soc. _. 


83. 


London Miss _ 


121. 


Am. Pres., No. 


147. 






All Societies .. 


76. 


132. 







78 The Health of Missionary Families in China 

In Table 58 the infections are rearranged by societies 
(the division into societies is somewhat different from that 
used in previous tables.) 

The societies with the smallest number of major infec- 
tions are not necessarily those with the lowest mortality. This 
may be due partly to comparative lack of medical care, inland 
location of stations, etc. It may be, also, that the members of 
some societies have been less careful than others in naming aU 
the sicknesses. 

Note that minor infections do not decrease at the same 
rate as major infections. Here again the neglect of mention- 
ing the trivial diseases may be a large factor. 

AGE AT TIME OF SICKNESS 

It is important to know at what ages children are most 
liable to contract the various diseases. Age at time of sick- 
ness was not recorded for many of the sicknesses. Data con- 
cerning nine of the more important diseases, totaling 1,291 
sicknesses, are recorded in Table 59. 

Children aged two {i.e., during the third year of life) 
show the largest number of infections. As has been remarked 
previously, this is the year of greatest susceptibility to un- 
healthy conditions. During this third year, dysentery and 
malaria are most common. Diarrhoea and smallpox are most 
prevalent in the first year — pneumonia in the second, scarlet 
fever in the sixth. 



Table 59 



AGE OF CHILDREN AT TIME OF SICKNESS. 





Number of Infections Occurring at Ages Specified. 


SICKNESS 


0-1 


1 


2 


3 


4 


6 


6-10 


11-15 


16 and 
over 


Total 


Dysentery 

Diarrhea 


63 
45 
23 

6 
17 

5 

4 
12 

2 


103 
43 
37 
10 
10 
5 
9 
13 
2 


112 
21 
24 

9 
15 
10 

5 
36 

1 


54 
9 

10 
6 
5 

15 
4 

32 


43 
6 
6 

14 
9 

17 
4 

20 
2 


31 
4 
4 

12 
3 

19 
9 

27 
1 


41 
2 
10 
21 
U 
46 
16 
51 
3 


11 

1 

1 

7 

1 

15 

17 

12 


2 


459 
132 


Pneumonia 

Diphtheria 


116 

86 

72 


Scarlet Fever 

Typhoid Fever 

Malaria . . _ 


134 

72 
207 


Tuberculosis 


13 


Total 


177 


232 


233 


135 


121 


110 


201 


65 


17 


1291 



The Health of the Children 



79 



MORTALITY RATE IN RELATION TO AGE 

Table 60 shows the percentage of the diseases which re- 
sulted fatally at various ages. In general, the younger the 
child, the greater the danger of death. During the first year, 
for instance, 60% of those contracting smallpox, 47% con- 
tracting infectious diarrhoea and 41% contracting dysentery 
died. These figures are unnaturally high for the reason that 
practically all the ages at death are known, whereas many of 
the ages for non-fatal sicknesses are not known. 



Table 60 



PERCENTAGE OF SICKNESSES RESULTING IN DEATH AT VARIOUS AGES. 





Age at Time of Sickness 


SICKNESS 


0-1 


1 


2 


3 


4 


5 
and 
Over 




Per Cent 
41 
47 
39 
33 
60 

""25"' 

16 

100 


Per Cent 
26 
40 
29 
70 

"26'" 

33 

8 

100 


Per Cent 

9 

20 

33 

66 

20 

10 

20 

9 

100 


Per Cent 
11 
11 
10 

...... 

25 
6 


Per Cent 

7 

"~2\" 
44 
24 
25 


Per Cent 
5 


Diarrhea, etc 


44 
13 


Diphtheria 


14 


Smallpox 


16 
11 


Typhoid Fever . .... 


11 


Malaria 


2 




62 







GENERAL HEALTH OF CHILDREN 

GEOGRAPHICAL LOCATION 

Under certain conditions of climate, malnutrition, etc., 
children may not have had any definite illnesses and yet be in 
poor health. To cover this point, parents were asked to 
specify if the past general health of children has been robust, 
good, fair, or poor. Since these terms are open to individual 
interpretation, the tabulation of answers received on this 
point is of value in only the broadest way. 



80 The Health of Missionary Families in China 



Table 61 



PAST GENERAL HEALTH OF CHILDREN— BY PROVINCES 





Total No. 
of Children 


Percentage Reporting Health op Children as 


PROVINCE 


Poor 


Fair 


Good 


Robust 




71 
232 
224 

83 
131 

67 


3 
3 
1 

4 
5 
3 


13 
17 
9 
6 
14 
3 


54 
45 
47 
52 
53 
40 


30 




35 


Chihli... 


43 




38 




28 




54 






North China 


808 


3 


10 


47 


38 








368 
78 
186 
170 
167 
56 
156 
22 
273 


3 
1 
4 

---- 

1 
4 
9 
2 


11 
10 
9 
9 
9 
18 
17 
19 
11 


44 
36 
42 
47 
44 
52 
47 
50 
47 


41 




53 




44 




44 


Hupeh _ . . . . 


45 




30 


Hunan . . 


32 


Kweichow 


27 




43 








1476 


3 


12 


44 


40 






Fiikipn 


167 

255 

15 


-___ 


9 
11 


51 
53 
73 


40 




33 


Yunnan 


27 






South China 


437 


1 


7 


59 


33 






Total All China 


2721 


2 


10 


50 


37 









In Table 61 is given the tabulation by provinces. South 
China shows the smaller proportion of children whom the 
parents specify as robust, 33%, as against 38% and 40% for 
North and Central China. (See Figure 41.) 

Though death is less common in the south, robust health 
is also less frequent. The explanation for this apparent con- 
tradiction lies in the fact that diseases of the south are those 
(such as malaria and intestinal parasites) which cause inva- 
lidism rather than death. Also, the climate is more debili- 
tating. 



MISSIONARY SOCIETIES 

Table 62 is arranged by societies with those reporting 
the highest percentage of robust children at the top. There 
is considerable variation (41%) betw^een the highest and low- 
est. Only 14% of all children are considered by their parents 
to be in less than good health. 



The Health of the Children 



81 



Table 62 



PAST GENERAL HEALTH OF CHILDREN BY SOCIETIES 





No. of 
Children 
Reported 


Percentage Reporting Health 


AS 




Poor 


Fair 


Good 


Robust 




67 
114 
119 
109 
158 

81 
519 
281 

92 
253 

73 
204 
381 

99 

65 




12 
10 

7 

10 
11 

7 

9 
12 
14 
11 

8 
12 
11 
16 
23 


36 
42 
47 
43 
44 
43 
47 
45 
46 
48 
53 
49 
51 
51 
61 


52 






48 






45 


Y. M.C. A 

Am. Meth. No 

Ch. Mis. Soc. 

Other Am. Soc 

Am. Vrea. No 


2 
2 
5 
1 
2 
2 
3 
3 
6 
4 
5 
5 


45 

44 
44 
43 
40 
38 


Other Eng. Soc 


37 


London Mis. Soc 

Scandinavian Soc. 


36 
33 




33 


Am. Baptist So _ 


27 




11 






Total 


2615 


3 


11 


47 


39 



MISCARRIAGES AND STILLBIRTHS 

An important phase of the problem, but one concerning 
"which little is said, is the number and cause of pregnancies 
which terminate disastrously. Such miscarriages, and still- 
births, are a heavy drain on the health and spirit of the 
mothers. 

"Were it not for difficult living conditions, missionaries 
should have a very low miscarriage rate because of their free- 
dom from syphilis. 

In the Babies' Hospital, New York City, among 193 syphilitic mothers 
22.4% of the 427 pregnancies resulted in stillbirth or miscarriage. Among 
another 150 syphilitic women, 17.2% of 1,001 pregnancies resulted in miscar- 
riage or stillbirth, while in another 150, with 826 pregnancies, who were 
known to be free from syphilis, the percentage was only 9.4.22 

Another authority23 states that 30% of pregnancies in which a parent 
is syphilitic result in the death of the foetus, which is three times the rate 
observed in non-syphilitic families. He states also that 3.5% of infant deaths 
are due to this disease. 

The pregnancies among missionary women which do not 
result in a living child form 15.2% of the total. This is sev- 
eral per cent higher than we might expect. The excess is 
accounted for by the unusual amount of travel and work to 
which missionary wives are subjected. 



82 The Health of Missionary Families in China 

GEOGRAPHICAL LOCATION 
Table 63 NUMBER AND PERCENTAGE OF STILLBIRTHS AND MISCARRIAGES BY PROVINCES 



PROVINCE 


Number 
Living 
Births 


Stillbirths 


MiSCARRIAGEE 


Total 
Per Cent 


Number 


Per Cent 


Number 


Per Cent 




85 
289 
270 
154 
84 
76 


1 
4 
5 
4 
2 
2 


1.17 
1.38 
1.85 
2.59 
2.38 
2.63 


9 
26 
37 
25 

5 
15 


10.6 
9.9 

13.7 

17.6 
5.2 

19.9 


11.8 


Shantung 


11.3 


Chihii.... 


15.5 




20.2 


Shensi 


7.6 




22.5 






North China.. . . 


958 


18 


1.87 


118 


12.7 


14.6 








94 
299 
448 
176 
216 
196 

70 
311 


...... 

4 
4 
2 

6 
7 

7 


'i'74' 
.87 

2.27 
.92 

3.06 

1.0 

2.25 


U 
24 
46 
20 
32 
25 
15 
42 


11.6 

11.3 

10.5 

10. 

11.4 

13.3 

23.7 

13.5 


11.6 


Honan . 


13. 




11.4 


Chekiang... 


12.7 


Hunan . ... 


12.3 


Hupeh ._ 


16.4 


Kiangsi 


24.7 




15.7 






Central China 


1740 


34 


1.95 


215 


12.8 


14.7 






Fukien 


182 
324 


"-"4" 


'\.'2i 


25 
57 


14.1 
19.3 


14.1 


Kwangtung- Yunnan _ .. 


20 5 






South China 


506 


4 


.79 


83 


17.6 


18.4 






All China 


3204 


59* 


1.84 


416 


13.4 


15.2 







*In three cases province not specified. 



Table 63 gives the number of miscarriages and stillbirths 
in relation to the number of living births. 

Stillbirths formed 1.84% and miscarriages 13.4% of the 
births. (Data concerning miscarriages was taken from 1,165 
histories, which reported 3,044 living births.) 

South China has fewer stillbirths and more miscarriages 
than the other sections. The total percentage for South China 
is slightly above North and Central China (18.4%, against 
14.6% and 14.7%). 

As stated before, 15 deaths of which the parent wrote 
merely ''died at birth" are classed as stillbirths. If these 
were living at the moment of birth, the rate would be 1.38% 
in place of 1.84%. In the general population of the United 
States stillbirths average about 4% of living births. 

Four families reported 2 stillbirths, 2 reported 3, the 
rest but 1. 



The Health of the Children 



83 



Table 64 



NUMBER OF MISCARRIAGES— BY PROVINCES 



PROVINCE 


Number of Families Reporting Specified Number 
of Miscarriages 


Total 
Families 


Total 
Mis- 
carriages 


Number 

Mis- 
carriages 







1 


2 


3 


4 


Marriage 


Manchuria 

Shantung 

Chihli _.. 


19 
78 
84 
18 
41 
15 


5 
11 

17 
3 
9 

8 


...... 

5 
1 

2 
2 


2 
...... 

1 


1 
...... 


25 
95 

109 
22 
56 
26 


9 
27 
37 

5 
25 
15 


.36 
.28 
.34 


Shensi 


.23 


Shansi. _ 


.44 


Kansu. _ 


.59 






North 


255 


53 


13 


10 


2 


333 


118 


.35 






Anhwpi 


23 
57 
126 
49 

64 
61 
21 
82 


4 
14 

18 
10 

10 
7 
5 

22 


2 
2 
11 
5 

4 
6 
2 
7 


1 

2 
2 

2 
...... 

2 


2 
1 


30 
75 
157 
64 

82 
75 
30 
113 


11 
24 

46 
20 

32 
25 
15 
42 


.37 


Honan 


.30 




.29 


Chekiang 

Hunan and 
Kweichow 


.32 

.39 
.32 


Kiangsi 


.50 


Szechuan 


.37 




447 


89 


38 


11 


3 


626 


215 


.34 






Fukien. 


61 
86 
71 


7 
28 


2 
3 


2 
5 


2 
2 


74 
124 

8 


25 

57 

1 


.34 


Kwangtung 

Yunnan . . 


.46 
.12 






South .. 


163 


37 


6 


7 


4 


206 


83 


.40 






Total- 


892 


179 


57 


28 


9 


1165 


416 


.36 







Table 64 shows the number of wives having certain num- 
bers of miscarriages, with the average number of miscarriages 
per family, by provinces. By this method of comparison, also, 
South China has a higher rate than other sections (40, as 
against 35 for North and 34 for Central China). 

23.5% of the wives reported having had one or more mis- 
carriages. Among 1,618 working women questioned in Man- 
chester, New Hampshire,'* the percentage was only 12. 



Table 65 



SUMMARY OF MISCARRIAGES— BY SECTIONS 





SECTION 


Percentage REPORTiNa Specified Nitmbbr 







1 


2 


3 


4 




76.6 15.9 
77.4 14.2 


3.9 
6.2 

2.7 


3.0 
1.7 
3.2 


0.6 


Central China 


0.4 


South China 


75.1 


17.0 


1.8 


All China 


76.5 


15.3 


4.8 


1.1 


0.7 



Table 65 shows that three-fourths of the wives have not 
had a miscarriage, and of those who have had, two-thirds 
have had only one. There is no great difference in the number 
by sections. 



84 The Health of Missionary Families in China 



Table 66 



MISSIONARY SOCIETIES 

NUMBER AND PERCENTAGE OF STILLBIRTHS BY SOCIETIES 



SOCIETIES 


Stillbirths 


Number 


Number per 100 
Living Births 


American Baptist, North 

American Church Mission 

American Methodist, North 

London Mission 

Y. M.C.A.- ... 


1 
2 
5 
1 
3 
2 


1.01 
2.56 
2.53 
1.22 
2.50 
.45 






Total, First Group .. . 


14 


1.37 






Canadian Methodist 


1 
4 
3 
2 
12 
2 


.74 


Church Missionary Society 

American Presbyterian, North 

American Lutheran Societies.. 


4.25 

.95 

1.45 


American Board Mission 


4.12 


English Baptist 


1.45 






Total, Second Group 


24 


2.16 






Other English Societies . . . . 


........ 

1 

3 

........ 




China Inland Mission 


2.89 


American Presbyterian, South 

Other European Societies . 


.94 

1.75 


American Baptist, South 




European China Island Mission . 


2.82 






Total, Third Group... 


21 


1.94 






All Societies 


59 


1.84 







Table QQ gives the number of stillbirths by societies. The 
first group has the fewest. 

Only two (3%) of the stillbirths occurred outside China. 
Cause of stillbirth was stated in only 17 cases, as follows: 
difficult labor, 8; overwork, 3; sickness, 4; fall, 1; travel, 1. 

In the question blanks sent out, persons were asked to make a check 
mark in case they did not care to answer the question concerning miscar- 
riages. Only one or two blanks were so checked. For the many blanks, 
therefore, on which nothing was written in the space for miscarriages, it is 
assumed that there were none. Unrecorded miscarriages would lower the 
miscarriage rates below the true figure. It is possible that some of the 
figures in these tables should be higher than they are. 



CAUSES OF MISCARRIAGES 

Table 67 gives the parents' statement of the principal 
causes of the miscarriages, occurring in China, and the num- 
ber of the pregnancy for each. Sixteen of the 377 are dupli- 
cates, two causes being assigned for one miscarriage. 

Miscarriages occur slightly later than living births. 35 
per cent of living births were first births, while only 23% of 
miscarriages were first pregnancies. Five per cent of the liv- 



The Health of the Children 



85 



Table 67 



CAUSES OF MISCARRIAGES WHICH OCCURRED IN CHINA 





Total 


Number 


OF M1SCARRUQE8 Occurring During Specifibd Pregnanct 




Ist 


2nd 


3rd 


4th 


5th 


6th 


7th 


8th 


9th 


10th 


Not 
Stated 


Geotiral Co>n)rriONs 
Overwork- 


65 
37 
11 
10 
9 
7 


10 

6 

.... 

2 
2 


15 
13 
2 

1 

"2 


11 

7 
1 
3 
2 


6 
6 

1 
2 
1 


5 
3 
2 
1 
1 
1 


8 

1 

.... 


3 

1 

.... 


1 

"2" 


--- 


1 


5 


Overexertion and Exercise. 
Debility... 




Nervousnesa. . . 




Revolution . . 




Fright and Anxiety 





Phtsical Agents 
A Fall or Injury. 


21 
11 
10 
3 
3 
7 


3 
3 
6 
1 
1 
2 


8 
3 
3 

2 

1 


1 
2 

.... 


3 
1 

"2 


2 
"2 


2 
2 





.... 


"V 


- - 


2 


Travel— Cart or Barrow... 
—Litter or Chair. . . 
— Steamer. 




— Rickshaw 

— Not Specified 


.... 


Pelvic Organs Abnormal.. 


43 


10 


6 


5 


8 


5 


5 


3 





— 


1 





Sickness 
Typhoid 


9 
7 
6 
4 
10 


2 
3 

1 
1 
4 


4 

1 
2 

"3" 


1 

2 

"2 
2 


1 
.... 

.... 


.... 

1 

1 


.::: 


1 


.::: 


;;;; 


:::: 




Eclampsia 




Malaria. . ... 




Dysentery.. 


1 










Miscellaneous Causes 


8 
68 
28 


2 
16 
9 


3 

12 
3 


1 

8 
5 


1 
8 
2 


1 
6 
4 


"9" 
3 


"3' 


"2 

1 


.... 


.... 


3 


Cause Not Stated 






377 


84 


83 


56 


50 


36 


31 


12 


7 


2 


3 


11 






Percentage of Total 


99 


23 


23 


16 


13 


9 


8 


3 


2 


1 


1 


.... 



ing births were sixth births or later, whereas 15% of the mis- 
carriages were sixth pregnancies or later. 

Overwork and over-exertion seems to cause later miscar- 
riages in larger proportion than travel or sickness. 

Eighty-seven per cent (362 out of 416) of all miscarriages 
occurred in China. Eighty-two per cent of married years were 
spent in China. Therefore miscarriages were slightly more 
frequent in China than at home. 

Table 68 compares the cause of miscarriage (in the cases 
in which a cause was assigned) in China and out of China. 

In spite of the fact that 27 of the 55 miscarriages due to 
physical injuries in China were thought due to peculiar modes 
of travel (cart, rickshaw, etc.) an even higher percentage of 
this class of miscarriages occurring at home, i.e., 8 out of 11, 
were assigiied to travel as a cause. Practically one-half of all 
miscarriages, in the opinion of the persons themselves, were 
due to overwork, debility, nervousness, fright, etc. 



86 The Health of Missionary Families in China 



Table 68 SUMMARY OF PRINCIPAL CAUSES OF MISCARRIAGE, OCCURRING IN AND 

OUTSIDE OF CHINA 


CAUSE OF MISCARRUGE 


OCCURRING IN CHINA 


OCCURRING OUTSIDE 
CHINA 


Number of 
Miscarriages 


Per Cent of 
Total 


Number of 
Miscarriages 


Per Cent of 
Total 




139 
55 
43 
36 


49 
21 
10 
14 


21 
11 
5 
6 


49 




25 




11 




16 






Total - 


273 


100 


43 


100 







Twenty-five per cent of miscarriages in China were 
blamed on "overwork," while 30% of those occurring, at home 
were laid at the same door. This would indicate that furlough 
is not a time of rest and recuperation for the wife, but one ot 
increased labor. 



CONDITIONS OTHER THAN HEALTH 

The welfare of children involves many more considera- 
tions than those of physical health. Though this study does 
not attempt to deal with these, their importance should be 
recognized. 

In some points, such as long separation from parents, 
lack of contact with large groups of other children, scarcity 
of high grade schools, missionary children are the losers. In 
other no less important respects, such as growth in an atmos- 
phere of religion and service, intimate family life, freedom 
from the dangers of our too complex social life (including 
attendance on moving picture shows), the broad education 
of travel, the growth of the cosmopolitan outlook, missionary 
children are the gainers. The social and religious condition 
of adult children of missionaries w^ould make an interesting 
study. 

The pictures on the two following pages show groups of 
missionary children in Peking. The majority are children of 
doctors. All of the third group have had protective inocula- 
tion against typhoid, paratyphoid, and diphtheria. 




Prospective missionary candidates — celebrating a birthday, at the Zon 




Missionary children have the finest of playmates — other missionary children. 
They do not always have as good a play place as have these children 




The camel train has arrived, witli sod for the playground. Children in China 
see many interesting things denied to their stay-at-home relatives 




A tree about which missionary children have 

played for fifty years — the only object in 

the compound left standing by the Boxers 



The Health of Married Adults 87 



PART II — Health of Married Adults 
INTRODUCTION 

This study is concerned principally with children because 
(1) of the writer's interest in missionary children and because 
of the lack of any previous study of them, (2) because the ques- 
tionnaire method is applicable for the collection of mortality 
statistics concerning children, as it is not for adults (since 
most families in which a parent has died are not now on the 
mission rolls), and (3) because the study of the adult body is 
too large an undertaking for one person. 

It is realized that the good health of adults is of more 
importance to the missionary cause than the good health of 
children. The writer has, in a previous paper"^ presented 
some of the reasons for modern medical care of the missionary 
body. It is encouraging to note that some of the boards have 
undertaken the study of the health of their workers (see pages 
95 and 112). Such studies are, however, rare and it seems 
worth while to present such facts concerning adults as are 
furnished by this questionnaire. 

Fifteen hundred and seventy-seven adults, about 60% of 
those who returned the question blanks, made statement con- 
cerning their own health. These had spent some 17,600 years 
in China, during which time they had contracted nearly 1,500 
cases of sickness. 

There are some duplications due to the fact that some 
parents are also children of missionaries still on the field. 
Though a number of these duplicates have been eliminated, 
probably a few remain. 



88 The Health of Missionary Families in China 

FACTS CONCERNING RESIDENCE AND MARRIAGE 

Table 69 (based on 1,064 reports) shows the average 
length of married life and the proportion spent in China. 
Those in the north have been married longer than those in 
the south. The proportion of married life spent in China is 
nearly the same for the three sections. 



Table 69 



AVERAGE NUMBER OF MARRIED YEARS AND PROPORTION 
SPENT IN CHINA— BY PROVINCES. 



PROVINCE 


Number 
Reporting 


Total 

Since 

Marriage 


No. Married 

Years In 

China 


Average No. Married 
Years 


Per Cent of 

Married Life 

In China 


Since 
Marriage 


In 
China 


Manchuria . 


23 
77 
101 
25 
23 


264 
1166 
1098 
330 
335 


337 
890 
883 
277 
299 


11.4 
15.1 
10.9 
13.1 
14.5 


10.3 
11.6 
8.7 
11.1 
13.0 


90 




76 


Chihli... 


80 




84 




89 






North China. - 


297 


3744 


3006 


12.6 


10.1 


80 






Kiangsu 


150 
26 
71 
64 
23 
62 
67 
9 
99 


1858 
392 
672 
932 
289 
660 
550 
128 

1127 


1517 
323 
593 
801 
241 
561 
430 
121 
913 


12.4 
15.0 

9.5 
14.5 
12.6 
10.6 

8.2 
14.2 
11.4 


10.1 
10.9 

8.3 
12.5 
10.5 

9.0 

6.4 
13.5 

9.2 


73 


Anhwei . 


72 


Honan _ 


88 


Chekiang... . . . . . 


86 




83 


Hupeh- 


85 


Hunan . . . . . 


78 




95 


Szechuan. . 


81 






Central China 


571 


6608 


5500 


11.5 


9.6 


83 








168 

110 

18 


727 

1216 

64 


570 
971 
49 


10.7 
11.0 
8.0 


8.4 
8.9 
6.2 


73 




80 


Yunnan. 


77 






South China 


196 


2007 


1590 


10.2 


8.1 


79 






All China. 


1064 


12359 


10096 


11.6 


9.4 


81 



Table 69 referred to Married years. Table 70 gives the 
years — whether married or unmarried — spent in China. Since 
the average years in China are 11.2, and the married years 
but 9.4, many persons must have been married after being on 
the field for a period. Here, as in Table 69, the missionaries 
in North China have been the longer on the field. This would 
indicate that the average missionary life in South China is 
shorter than in the north by 20%. 

This proportion holds good for both married years and 
total years. Not only have couples in North China been in 
China longer, but also they have been married longer. This 
means that the percentage of married life spent in China is 
about the same for the three sections. Married years in China 
are exclusive of periods in which both parents were on 
furlough. 



The Health of Married Adults 



89 



Table 70 



AVERAGE NUMBER OF YEARS ADULTS (NOW MARRIED) HAVE 
BEEN RESIDENTS IN CHINA— BY PROVINCES 



PROVINCE 


Number I 


uEPORTINQ 


Av. Yr3. 


m China 


Total 
Husband and Wife 


Total 
Years 




Husband 


Wife 


Husband 


Wife 


Number 
Reporting 


Av. Yrs. 
in China 




10 
42 
63 
34 
16 
15 


12 
46 
62 
32 
13 
15 


10.9 

12.9 

11. 

12.8 

10.8 

16.5 


9.2 
13.4 
10.4 
11. 

9.8 
17.1 


22 
88 
125 
66 
29 
30 


10. 

13.3 

10.7 

11.9 

10.3 

16.8 


222 
1171 
1338 
788 
316 
497 


Shantung 


Chihii 


Shansi . .... 


Shensi... . 


Kansu 




North China . . - 


180 


180 


12.5 


11.8 


360 


12.2 


4388 




Kiangsu 


86 
13 
22 
49 
26 
28 
36 
32 
62 


88 
9 
22 
45 
35 
21 
38 
31 
54 


11 

17.3 
16. 
11.5 
12.2 
14. 
8.1 
11.5 
12.3 


9.8 
14. 
15.2 

9.8 
14. 
11.8 

7.7 

9.6 
12.3 


174 
22 
44 
94 
61 
49 
74 
63 

116 


10.4 
16. 
15.6 
10.6 
13.1 
13.2 
7.9 
10.6 
12.3 


1817 
351 
687 

1004 
791 
638 
583 
667 

1426 


Anhwei... 


Chekiang. . 


Honan ..... ...... 


Kiangsi 


Hupeh ... 


Hunan .... . 


Kueichow ... 






Central China 


354 


343 


11.8 


10.9 


697 


11.4 


7933 








50 
76 
5 


42 
73 

8 


8.1 
10.5 
21. 


9.4 
9.5 
12.6 


92 

149 

13 


9.7 
10. 
15.8 


805 
1497 
207 








South China. .. 


131 


123 


10. 


9.5 


254 


9.8 


2494 




For All China 


665 


646 


11.6 


10.8 


1311 


11.2 


14663 





Table 71 



NUMBER OF YEARS ADULTS (NOW MARRIED) HAVE 
BEEN RESIDENTS IN CHINA— BY PROVINCES 



PROVINCE 


Number Resident in China Specified Number of Years 






0-5 


6-10 


11-15 


16-20 


21-25 


26-30 


31-35 


35-39 


Total 




3 
19 
49 
21 
4 
2 


9 
23 
23 
12 
10 

4 


8 
14 
15 
13 
4 
4 


2 
11 
17 
10 
4 
5 


1 
9 
9 
3 
2 
5 


"io' 

5 
5 
2 
5 


"2 

7 


.... 


23 
88 
125 


Shantung 


ChihJi... 




65 
26 






25 




North China 


98 


81 


58 


49 


29 


27 


9 


1 


352 






55 

6 

8 

37 

2 

21 

24 

17 


49 
2 
4 
15 
24 
5 

60 
44 


25 

"Y 

15 
20 
1 
37 
24 


29 
3 

13 

13 
7 
8 
7 

13 


13 
8 
8 

10 
5 
9 
5 

11 


4 
3 
2 
2 
2 
1 
2 
3 


1 

"2 

1 
1 

"2 


"2 


176 




22 




44 




94 




61 




46 




135 




114 








170 


203 


129 


93 


69 


19 


7 


2 


692 








36 
46 


24 
53 


19 
31 


10 
15 


3 
4 


3 
6 


""3" 




95 




158 








82 


77 


50 


25 


7 


9 


3 


.... 


253 






All China— Husband 

Wife 


167 
183 


172 
189 


132 
105 


82 
85 


64 
41 


30 
25 


13 
6 


2 
1 


662 
635 






All China— Husband- 
and Wife. 


350 


361 


237 


167 


105 


55 


19 


3 


1297 



90 The Health of Missionary Families in China 

Table 71 presents the number of years adults have been 
resident in China, exclusive of time on furlough, by provinces. 
Fifty-five per cent have been in China ten years or less, and 
but 13% for 20 years or more. Table 70 showed that wives 
had spent 7% less time in China than their husbands. This 
table shows that the wives who have been in China ten years 
or less are relatively more numerous than the husbands. 



Table 72 



NUMBER AND YEARS OF MARRIED LIFE AND PERCENTAGE 
OF MARRIED LIFE SPENT IN CHINA— BY SOCIETIES 





Total No. Married Years 


Number Married Years 
Spent in China 


Per Cent 
OF Mar- 
ried Yrs. 


SOCIETY 


No. Fam- 
ilies Re- 
porting 


No. of 
Years 


Average 
No. of 
Years 


No. Fam- 
ilies Re- 
porting 


No. of 
Years 


Average 
No. of 
Years 


IN China 


American Baptist, North.. 


44 


518 


11.7 


44 


403 


9.1 


77 


American Church Mission. . 


44 


335 


7.6 


38 


185 


4.8 


55 


Am. Methodist, North 


73 


961 


13.1 


72 


824 


11.4 


85 




34 


426 


12.5 


29 


287 


9.8 


91 






Y. M.C.A..-. 


63 


465 


7.3 


63 


290 


4.6 


62 


Other American Societies. . 


22,5 


2194 


9.7 


214 


1613 


7.5 


73 




4S1 


4S99 


10.2 


453 


3436 


7.5 


70 






Canadian Methodist 


47 


437 


9.2 


45 


316 


7.02 


72 


Church Miss. Society. 


38 


431 


11.4 


30 


335 


11.1 


81 


Am. Presbyterian, North.. 


125 


1532 


12.2 


113 


1254 


11.09 


82 


Am. Lutheran Societies 


53 


353 


6.6 


46 


264 


5.7 


75 


Am. Board Mission _ 


51 


607 


11.9 


51 


479 


9.4 


77 




34 


400 


11.7 


29 


209 


7.1 


52 






Total 2nd Group 


34S 


3756 


10.9 


314 


2856 


9.1 


76 






Other English Societies 


103 


1398 


13.4 


97 


1112 


11.4 


79 


China Inland Mission 


151 


2091 


13.8 


139 


1733 


11.7 


82 


Am. Presybterian, South. . 


28 


436 


15.5 


28 


382 


13.6 


87 


Other European Societies. . 


63 


720 


11.4 


61 


607 


10.0 


84 


Am. Baptist, South 


41 


638 


15.5 


38 


448 


11.7 


70 


European C. I. M 


41 


484 


11.8 


38 


399 


10.5 


82 


Total 3rd Group 


429 


5768 


13.5 


406 


4681 


11.5 


81 






Societies Not Stated 


2 


28 


14. 


2 


26 


13. 


92 


Total 


1259 


14450 


11.4 


1179 


10996 


9.3 


77 


MARRIED; years not 
stated (average taken) 


40 


456 


11.4 


122 


1133 


9.3 




Grand Total 


1300 


14906 


11.4 


1300 


12132 


9.3 


81 







The Health of Married Adults 91 

Table 72 (based on 1,300 reports) shows the married 
years, and the portion spent in China according to societies, 
arranged in the order of child mortality, the lowest at the top. 
For the three big groups, child mortality, as has been seen, 
varies with the average age of the children. 

This table shows, as one would expect, that mortality 
varies also with the length of time of marriage. It also shows 
(last column) that mortality for the big group varies in- 
versely with the time spent on the field, i.e., the first group, 
in which parents have spent only seven of ten married years 
on the field, have a lower rate than the group which have spent 
eight out of ten. This may mean that the first group has had 
more frequent furloughs, or a larger period of marriage be- 
fore coming to the field. 

A separate tabulation (table not printed) for families 
with and without children, shows that families with children 
of group 1 have been married 10.7 years; of group 2, 11.3 
years, and of group 3, 13.5 years. Those without children 
have been married only about half this number of years. 

MORTALITY AMONG ADULTS 

As has been explained, this questionnaire method is of no 
value for arriving at a mortality rate for adults. However, 
the list of diseases of which parents have died is of interest. 
Of 72 married adults who had died, the following are the 
stated causes of death. Dysentery, 9; typhoid, 6; cancer, 6; 
tuberculosis, 5 ; childbirth, 5 ; 4 each of smallpox, typhus, and 
malaria ; 3 each of pneumonia, puerperal fever, cholera, sprue, 
and kidney disease; 2 each of apoplexy, heart trouble, and 
appendicitis, and 1 each of fever, sunstroke, blood poisoning, 
hemorrhage, operation, meningitis, diarrhoea, and urasmia. 
Fifty — more than two-thirds — were due to infections. Eight 
mothers died of diseases caused by confinement, of whom 
three died of childbirth fever. 

Of missionaries who died during 1917, as reported by the China Mission 
Year Book, 28 of the 56 deaths in which cause of death was recorded, died of 
infectious diseases. The list includes: typhus fever, 5; typhoid fever, 4; 
dysentery, 3; smallpox, 2. An interesting fact is the comparative immunity 
enjoyed by missionaries in China during the influenza pandemic of that 
year. 30% of missionaries dying outside of China died of influenza, whereas 
only 2% (viz., one) of those dying in China succumbed to that disease. 

MORBIDITY AMONG ADULTS 

Table 73 shows the number of illnesses in order of fre- 
quency for husband and wife by provinces. 



92 The Health of Missionary Families in China 



Table 73 



GEOGRAPHICAL LOCATION 

INCIDENCE OF PRINCIPAL INFECTIONS AMONG ADULTS BY PROVINCES 





PROVINCE 


SICKNESSES 


CO 


5 
la 
1 


a 

3 

a 




"a 

CO 


1 

.a 

CO 


1 


2 


1 

a 
< 


d 



60 

'■% 



W 


D. 




ja 
% 

a 

03 

a 
X 


e 

3 
ja 

CO 


3 


a 
<a 

3 
3 




Number or Persons Reporting 




Male 


17 


63 


77 


40 


15 


18 


101 


16 


41 


53 


17 


41 


59 


74 


54 
55 


91 




Female. -- 


16 


65 


81 


42 


15 


18 


106 


17 


43 


57 


18 


45 


59 


74 


89 




Total... 


33 


128 


158 


82 


30 


36 


207 


33 


84 


110 


35 


86 


118 


148 


109 


180 








Numi 


3ER OF Cases op Sickness per 100 Persons 






Total— All 
Sicknesses 


Male 

Female... 
Both ... 


102 
96 

87 


56 
71 
63 


56 
69 
62 


55 
69 
61 


48 
34 
40 


94 
50 
72 


86 
105 
95 


100 
65 

82 


85 
81 
85 


99 
65 
81 


147 
156 
151 


112 
69 
89 


105 
106 
106 


65 
54 
60 


78 
71 
74 


100 

85 
93 


Total of Sick- 
nesses Listed 
Below 


Male 

Female... 
Both... 


90 
60 
75 


56 
59 
57 


50 
49 
50 


52 
52 
52 


42 
14 
24 


85 
25 
54 


82 
88 
85 


94 
53 
73 


79 
49 
63 


92 
51 
70 


135 
130 
131 


106 
66 

88 


102 
95 
98 


61 
48 
54 


74 
65 
68 


92 

84 
88 


Malaria 


Male 

Female... 
Both... 


6 
6 
6 


8 
5 
6 


6 
5 
5 


7 
7 
7 





30 
12 
21 


21 
30 
25 


48 
24 
36 


29 
5 
17 


45 
23 
34 


59 
55 
57 


30 
20 
25 


25 
20 
22 


20 
8 
14 


27 
23 
25 


35 
32 




3 


Dysentery 


Male 

Female... 
Both... 


30 
18 
24 


17 
14 
15 


13 

7 
10 


17 
12 
15 


13 
13 
13 


18 
6 
11 


14 

18 
16 


24 
"12" 


17 

24 
21 


19 
7 
13 


29 
17 
23 


37 

9 

25 


35 

27 
32 


16 
7 
12 


9 
9 
9 


17 
12 
15 


Typhoid Fever 


Male..... 
Female... 
BotJi ... 


24 
19 
22 


6 
9 

7 


12 
2 
7 


5 

7 
6 


7 
""4" 


22 
6 
14 


7 
9 

8 


6 
18 
12 


10 

7 
8 


5 
""3' 


12 
22 
17 


15 
9 
12 


10 
10 
10 


12 
9 
10 


9 
2 
5 


5 
3 
4 


Nervous Break- 


Male 

Female... 
Both... 


6 
12 
9 


1 
6 
3 


1 

5 
3 


7 
2 
4 






9 
4 

7 


3 


2 
2 
2 


5 
7 
6 


:::: 


7 
5 
6 


5 

10 

7 


3 
6 
4 


2 
2 
2 


7 






7 








7 












Male..... 
Female. . . 
Both... 





8 
5 
6 


8 
6 
7 


2 
5 
3 


7 


6 


6 
5 
5 


6 
"3" 


2 
2 
2 


2 
4 
3 


— 


7 
7 
7 


5 
2 
3 


1 
1 

1 


6 
6 
6 


4 
3 




3 


3 


3 




Male 

Female.. - 
Both... 


24 
"l2 


"I' 

2 


3 
4 
3 








4 
4 
4 


.... 


2 


2 
2 
2 


12 

28 
20 


5 
"'2" 


5 

7 
6 


4 
3 
3 


4 
8 
6 


7 


Diarrhea, etc 








6 








.... 


1 


6 














Male 


.... 


5 


3 

1 
2 


2 
2 
2 






6 
5 
5 


3 


2 
.... 


5 
4 
5 


6 


.... 


2 
3 
3 


.... 

1 


13 
11 
12 


8 


Roundworms 






7 


Botn ... 


.... 


3 






3 


.... 


8 












Male 

Female. -. 
Both.... 


:::: 


1 
5 
3 

3 
3 
3 

1 
5 
3 

3 










5 
3 
4 

5 
4 
4 


.... 


5 


"2 

1 

5 

2 
4 


12 
3 














1 
1 

1 

1 
1 

3 

4 
6 
5 


5 
2 

2 
5 
3 

5 
7 
6 

2 






7 
3 

5 

"2" 

5 
2 
3 


5 
2 

3 
5 

4 


7 
4 

4 


4 
2 

2 


7 








.... 


2 


4 




6 
""3" 


""5' 
3 




Appendicitis 

Operation 






Female.. - 
Both ... 


6 
3 


6 
3 

6 


mi 


1 


2 


1^ 


1 




Male 

Female.-. 
Botn ... 


3 






















1 








1 

1 
3 
2 

2 


3 














2 




7 


6 


5 
2 
3 





— 


3 
3 
3 

3 
2 
2 


4 








Male 


1 


Typhus Fever 










Botii_._ 


Hi: 


1 


3 


3 








2 


h:: 


1 




2 
.... 


6 
6 
6 


"Y 
3 








4 


Tuberculosis 


Female... 
Botn ... 





1 
1 


1 

1 








1 








1 






1 


.... 






2 
















Male 














2 

1 
2 


.... 


2 
2 
2 








3 

2 

2 






1 




Female... 
Both ... 


.... 


1 

1 


4 

2 


2 
1 


































1 








1 1 









The Health of Married Adults 



93 



Since many did not state ages or years of residence, the 
reckoning, is on the basis of the number of persons. This is a 
bit unfair to the Northern provinces, since the adults in the 
North have averaged more years in China than those in the 
South. As in the similar table for children, the recorded num- 
ber of illnesses from malaria, dysentery, diarrhoea, round 
worms, etc., is far below the actual number, since many rein- 
fections are not recorded. 

It will be noted at once that the distribution of certain 
diseases is not the same as for the children. Acute intestinal 
infections, dysentery, diarrhoea and typhoid are relatively 
more common in Central China than was the case with the 
children. This is especially true of dysentery. The fact that 
bacillary dysentery is more prevalent in the north and amebic 
dysentery in the south may have something to do with this 
phenomenon. The rarity of amebic dysentery among Filipino 
children has been noted by Haughwout.'^ 

A needed piece of research is an investigation into the 
incidence of the two types of dysentery among the Chinese, 
both adults and children, and for the various sections of China. 




-^ OF TOTAL MiiiDlA DY.FMTKILY TYPHOID NtHVOUS INTESTIMW. 5 p 

ILLNCSIES '^*'-*'<-'* DY3ENTER.Y TYPHOID 6^^;^,^ po„H iNTtCTlONS ^**''^^<^°^ 



Figure 38. Number of various sicl^nesses per 100 married mis- 
sionaries by sections. (Illustrating part of Table 74.) 



Table 74 is a compression of Table 73 into groups of 
provinces. The distribution of the principal diseases is illus- 
trated in Figure 38. 



94 The Health of Missionary Families in China 



Table 74 



NUMBER OF SICKNESSES PER 100 MARRIED MISSIONARIES, IN 
ORDER OF FREQUENCY— BY SECTIONS 





SEX 


North 
China 


Central 
China 


South 
China 


AU China 




Number op Pehsons Rbportino 




SICKNESSES 


Male 


230 


402 


145 


777 


Total 






Number 




Female 


237 


419 


144 


800 






of 




Total 


467 


821 


289 


1577 












NUMBHU 


OP Sicknesses per 100 Persons 






Male 


60 
66 
63 


92 

84 
88 


92 
86 

89 


83 
76 
81 


644 


Total— All Sicknesses- 


Female 

Both 


630 




1274 










Male -. 


59 
49 
52 


88 
71 
79 


81 
76 
80 


79 
66 
72 


606 




Female . 


524 




Both 


1130 










Male.... .... 


8 
5 
7 


29 
21 
25 


32 

28 
30 


23 

18 
21 


182 


Malaria . 


Female 


144 




Both.. 


326 










Male 


16 
11 
13 


22 
14 
IS 


14 
11 
13 


19 
13 
15 


149 


Dysentery. . 


Female 


103 




Bach 


250 










Male - 


10 
6 

8 


9 
8 
9 


8 
3 
5 


7 
7 

8 


72 


Typhoid Fever. _. 




55 




Both. . 


127 










Male- - - 


3 
5 
4 


5 
5 
5 


5 

5 
5 


4 
5 
5 


34 




Female. 


40 




Both 


74 










Male... 


6 
4 
5 


4 
3 
3 




4 

4 


5 
4 
4 


37 


Influenza _ . 


Female 


29 




Both 


66 














Male.... 


3 
3 
3 


4 
4 

4 


6 
6 
6 




4 


31 






4 

4 


31 




Both 


62 










Male.... 


3 
1 

2 


3 
3 
3 


12 
9 
10 


4 
3 
4 


33 


Roundworms. . . . 


Female. 


25 




Both 


58 










Male-... 


...... 

2 


2 
4 
3 


...... 

3 


1 
4 
2 


10 


Sprue ... 


Female 


29 




Both ... 


39 








Appendicitis Operation 


Male 

Female 


2 
2 

2 


3 
3 
3 


1 
1 
1 


2 
2 


17 
19 




Botn - 


36 










Male 


1 


1 
1 
1 


1 


1 
1 
1 


5 


Scarlet Fever 


Female 


9 




Both... 


14 










Male. _ 


1 
4 
3 


2 
1 
2 


2 

1 
1 


2 
2 

2 


11 


Smallpox 


Female. _.. 

Both 


17 




28 












4 
2 
3 


2 

1 
2 


1 


2 
1 

2 


19 


Typhus Fever... 


Female 


11 




Both 


30 












1 


2 

1 
1 


1 
3 


2 
1 
2 


8 






12 




Both 


20 













The Health of Married Adults 



95 



Malaria and dysentery are more frequent among men 
than women. This may be because of greater conscientious- 
ness on the part of the wives in guarding against infection, 
or because they do not travel about so much as their husbands. 
Also, the wives have not been in China as long as their hus- 
bands. (Table 71.) Spnie is much more prevalent among 
wives. Nervous breakdowns are only slightly more frequent. 
(Figure 39.) 

In addition to the cases of sickness 
listed in the table, the following causes of 
sickness among married missionaries 
were named: Pelvic operations, 41; puer- 
peral fever, 11; eclampsia, 9; obstetric 
disaster, 4; ectopic pregnancy, 2; pneu- 
monia, 21; cholera, 14; heart disease, 12; 
kidney disease, 12; diphtheria, 11; can- 
cer, 8; dengue, 8; meningitis, 4; tape- 
worm, 3; trachoma, 2; paralysis, 2; dia- 
betes, 2, and one each of relapsing fever, 
plague, angina pectoris, progressive mus- 
cular atrophy, syphilis (a surgeon in- 
fected during an operation), apoplexy, 
sunstroke, anaemia. Total, 174. 

The diseases named in Tables 73 and 
74 refer only to those contracted in China 
Besides these, 162 were named as con 
tracted at home, as follows: Scarlet fever 
39; typhoid, 37; pneumonia, 20; appendi 
citis, 16; nervous breakdown, 13; malaria, 12; diphtheria, 10; tuberculosis 
4; smallpox, 3; heart disease, 2; influenza, 2, and one each of kidney disease 
meningitis, dysentery, and sprue. 

So few of the correspondents put down their ages, that a general com- 
parison of morbidity in China and at home on the basis of years of residence 
is impossible. 

Table 75 shows the number and proportion of Church 
Missionary Society missionaries, as reported by Price," inva- 
lided home from the sections of China. Neurasthenia (nerv- 
ous breakdoAvn) is by far the most common cause. Contrary 
to statistics of this study, it is much more frequent in North 
China. 




Figure 39. Incidence of cer- 
tain sicknesses among hus- 
bands and wives. (Illustrat- 
ing part of Table 74.) 



Table 75 



CAUSES OF INVALIDING OF 203 CHURCH MISSIONARY SOCIETY 
MISSIONARIES. 



SICKNESS 


North 
China 


Centra! 
China 


South 
China 


All 
China 




Per Cent 


Per Cent 


Per Cent 


Per Cent 




44.3 
.■Jl 

13.8 
8.6 
5.1 
5.1 

58"" 


17.7 
12.6 
7.6 
11.4 
7.6 
8.8 
5. 
2.5 
3.8 

79"" 


10.6 
7.5 
7.5 

15. 
3. 

18. 

"4".5 

"3"' 
66. 


25. 


Insanity - - - 


8.8 




9.8 


Malaria _ ... -_... 


11.8 




5.9 




10.8 


Typhus Fever. . .. . - . . . 


1.9 




2.9 


Smallpox __ .--... 


1.4 




.9 




203. 







96 The Health of Missionary Families in China 



PERIOD WHEN SICKNESSES ARE CONTRACTED 

The attempt is made in Table 76 to ascertain the danger 
period for various diseases. 

The date of infection had to be calculated from the age of 
the person, the age at time of infection and number of years 
in China. This roundabout method gives opportunity for 
error. Also the number of cases in which the necessary data 
was given is small. Second or subsequent attacks are included. 
The numbers should be compared with the bottom line, which 
gives the number of missionaries who have spent the specified 
year in China. Few questionnaires reached those who had 
been less than a year in China. 



Table 76 



MARRIED MISSIONARIES— NUMBER OF YEARS AFTER ARRIVING 
IN CHINA WHEN SICKNESSES WERE CONTRACTED. 







Number op 


Sicknesses in 


Specified Year After Arrival 




SICKNESS 


0-1 


1 


2 


3 


4 


5-9 


10-14 


15-19 


20-24 


25- 


All 
Years 


Dysentery 


22 
17 
27 
8 


22 
7 

16 
4 
2 
4 
2 


20 

"ll" 

4 
3 
3 
2 


11 

5 
11 

1 
...... 


9 
2 
10 
1 
2 
9 
3 


32 
20 
31 

1 
6 
5 
6 


14 

8 
16 


3 
5 
2 


1 
1 


1 


134 


Typhoid Fever 


66 


Malaria . . 


129 


Smallpox. 


20 


Typhua Fever . 


5 
3 
5 


2 
1 

2 


20 


Nervous Breakdown 


5 
1 


1 




34 


Sprue 


21 










Total 


80 


57 


47 


31 


36 


101 


51 


15 


5 


1 


404 






Number of Missionaries 




1278 


1229 


1159 


1074 


1005 


627 


367 


211 


81 





Smallpox is defijiitely more common immediately after 
arrival in China. Other infections show the same thing in less 
marked degree. Only 54% of the sicknesses named were con- 
tracted after three years in China, though 84% of the mis- 
sionaries have been in China more than that length of time. 

This decreasing morbidity may be due either to increas- 
ing immunity to disease, or to increasing knowledge and care 
in prevention. It should be noted, however, that long resi- 
dence does not confer immunity. Infections are common after 
the fifth year. 

Of the typhoid cases, 36% occurred in the first three years 
on the field. Among British missionaries" from all mission 
fields, of 187 cases of typhoid, about half occurred during the 
first three years and 70% during the first six years. 



The Health of Married Adults 



97 



PROPORTION WITHOUT SERIOUS SICKNESS 



Table 77 



PERCENTAGE OF HUSBANDS AND WIVES WHO HAVE NOT HAD 
ANY IMPORTANT SICKNESS WHILE LIVING IN CHINA. 



PROVINCE 


Number 

Returning Question 

Blanks 


Per Cent Who 

Answered Queslion 

ConcerninR Personal 

Health 


Of Those 

Answering, Per Cent 

Who Had Not Been 

Seriously Sick 




Husband 


Wife 


Husband 


Wife 


Husband 


Wife 


Manchuria 


26 
95 
107 
55 
26 
26 


26 
97 
109 
57 
26 
26 


65 

65 
72 
72 
58 
70 


01 
67 
71 
74 
58 
70 


65 
52 
61 
50 
60 
33 


56 


Shantung... . . .... 


50 


Chihli 


55 


Phansi 


52 


Sheasi- -. .- .----.. 


66 




55 






North China 


335 


341 


70 


70 


55 


54 








158 
30 
73 
83 
32 
65 
74 
9 

112 


160 
28 
74 
84 
31 
70 
74 
9 

113 


64 
53 
56 
64 
56 
63 
68 
88 
66 


66 
60 
56 
67 
58 
64 
68 
88 
66 


45 
44 
21 
60 
28 
24 
35 
50 
65 


45 




47 




33 


Honan 


51 




5 




44 




33 




50 




58 








636 


643 


63 


65 


41 


44 








75 

123 
9 


76 

126 

9 


72 
67 
55 


72 
60 
55 


47 

48 
40 


43 




48 












212 


211 


68 


68 


47 


45 






All China 


1183 


1171 


65 


68 


47 


47 








Figure 40. Percentage of mar- 
ried missionaries who have 
not had serious sicknesses 
while living in China, by 
sections. (Illustrating Ta- 
ble 77.) 



We have seen that sickness 
among adults is more frequent in 
Central and South China than in 
North China. This tabulation in- 
cluded some minor ailments. Also 
some of the persons had had sev- 
eral different diseases. 

Table 77 shows what propor- 
tion of adults have not been seri- 
ously ill in China. Slightly more 
than half (53%) of those who an- 
swered had had a serious disease 
(round and tape worms, dengue, 
and trachoma, etc., not counted). 
Central and South China show a 
larger proportion of persons who 
have been sick than does North 
China, just as (Table 74) these 
sections show a larger proportion 
of sicknesses. 



98 The Health of Missionary Families in China 



PAST GENERAL HEALTH 

GEOGRAPHICAL LOCATION 



Table 78 


PAST GENERAL HEALTH OF HUSBAND AND WIFE 
-BY PROVINCES. 






isi 




HUSBAND 1 




WIFE 


S [PROVINCE 

1^ 


No. 
Report- 
ing 


Perce 
G 


NTAGE Rl 
ENERAL i 


BPORTING Past 

EALTH As 


No. 
Report- 
ing 


Percentage Reporting Past 
General Health As 


Poor 


Fair 


Good 


Robust 


Poor 


Fair 


Good 


Robust 


Manchuria 

Shantung 

Chihli .. 


17 
57 
80 
42 
18 
19 


"2 

1 


6 
12 

4 
19 

2 
21 


76 
51 
50 
62 
48 
47 


18 
35 
44 
19 
50 
31 


17 
58 
78 
41 
19 
19 


6 
3 
1 


29 
24 
14 
12 
32 
26 


53 
60 
54 
71 
52 
53 


12 
12 
31 


Shansi 


17 
16 




21 






North China. - 


233 


1 


11 


55 


33 


132 


1 


20 


59 


20 




99 
17 
52 
36 
16 
44 
49 
8 
78 


1 
.... 


9 

"K 
8 

25 
7 

14 

"n 


58 
76 
62 
58 
56 
50 
59 
88 
54 


31 

24 
31 
33 
18 
43 
27 
12 
32 


100 
16 
50 
38 
17 
46 
49 
7 
79 


3 

"z 

2' 

4 

.... 


15 

25 
22 
19 
23 
17 
37 
57 
20 


59 

50 
50 
57 
59 
59 
49 
43 
54 


23 




25 




28 


Chekiang 


21 

18 




22 




10 


Kueiehow 

Szechuan 


"24" 


Cent. China. - 


399 


2 


9 


62 


28 


402 


1 


26 


51 


19 




56 

80 

5 


"2 


9 
13 
20 


63 
61 

80 


28 
24 


57 
79 
5 


2 
4 


21 
32 
20 


60 
48 
60 


17 


Kwangtung 

Yunnan 


16 
20 


South China. 


141 


1 


14 


68 


17 


141 


3 


24 


56 


18 


All China 


773 


1 


11 


58 


30 


775 


3 


23 


54 


20 


Husband & Wife. 


1548 


2 


17 


56 


25 


.... 


— - 


.... 


.... 


.... 




Figure 41. Percentage of husbands, 
wives, and children whose past gen- 
eral health has been robust, by sec- 
tions. (From Tables 78 and 61.) 



Table 78 and Figure 41 
show the past general 
health of husband and wife 
by provinces. The wives in 
various sections differ but 
little. Husbands are con- 
siderably above their wives 
in North China, and for all 
China show 50% more who 
have been in robust health 
(30% against 20%). This 
in spite of the fact that men 
have a higher morbidity 
rate than women. Evident- 
ly the general conditions of 
work, and of child bearing 
(normal confinements are 
not counted as sicknesses) 
are important causes of ill 
health for women. Only 



The Health of Married Adults 



99 



25% of the missionaries consider that their health has been 
robust. Does this fact bear any relation to the progress of 
the church in China? 

Report made in 1913 by British societies"^ showed that 
twice as many women as men were invalided home from Cen- 
tral and South China. 



Table 79 



MISSIONARY SOCIETIES 

PAST GENERAL HEALTH OF HUSBAND AND WIFE 
BY SOCIETIES 





HUSBAND 


WIFE 




No. 
Re- 
port- 
ing 


Percentage Reporting 

Past General Health 

As 


No. 
Re- 
port- 
ing 


Percentage Reporting 

Past General Health 

As 




Poor 


Fair 


Good 


Robust 


Poor 


Fair 


Good 


Robust 


Y.M. C. A - 

London Miss. Soc..-. 


39 
25 

86 
31 
31 
48 
33 
72 
24 
139 
21 
31 
96 
10 
50 


5 
.... 

"z 

1 
.... 

"2 


8 
8 
8 

12 
6 
2 

22 
8 

12 

11 
9 

12 
9 

30 

12 


46 
60 
53 
55 
58 
61 
51 
56 
63 
58 
62 
63 
68 
50 
64 


41 
32 
38 
32 
35 
37 
24 
35 
25 
30 
29 
25 
23 
20 
22 


37 
24 
91 
31 
30 
47 
33 
72 
28 
143 
23 
32 
93 

50 


3 

23 
1 
3 

"\' 

"2 
4 
3 

1 


5 

'31' 
24 
16 
22 
10 
18 
25 
23 
17 
19 
26 
22 
38 


59 
42 
45 
49 
64 
57 
60 
62 
46 
57 
65 
56 
53 
55 
54 


33 
33 
23 




24 




20 


Am. Methodist, North 


17 
30 


American Presbyterian, North 

Church Miss. Soc -_.. 


18 
25 
17 




17 




19 


China Inland Mission 

German Societies... 


20 
22 

8 






All Societies ._. - 


736 
1479 


1 

1 


10 
15 


58 
57 


31 

26 


743 


2 


21 


55 


20 


All Societies— Husband and Wife 






Table 79 gives the condition of health by societies, those 
reporting the highest percentage with robust health being 
placed at the top. The order, in general, is similar to that 
found in the tables showing mortality of children. It is rea- 
sonable to suppose that both parents and children suffer from 
the conditions which cause ill health. 



100 The Health of Missionary Families in China 



PART III— Some Factors in Prevention of Disease 
THE PREVENTABLE DISEASES 

The largest results in life-saving come from concentration 
of effort on the diseases which are causing the greatest loss, 
and which are most easily prevented. The degree of prevent- 
ability is a most important factor. 

The ratio of preventability of death for various diseases has been 
worked out by Professor Irving Fishers of Yale. Some of those of most 
importance in China are: Prematurity, 40; scarlet fever, 50; diarrhoea and 
enteritis, 60; dysentery, 80; diphtheria, 70; typhoid fever, 85; malaria, 80; 
smallpox, 75; broncho-pneumonia, 50; meningitis, 70; tuberculosis, 75. This 
percentage of the present number of deaths could be prevented if "the knowl- 
edge now existing among well-informed men in the medical profession were 
actually applied in a reasonable way and to a reasonable extent." 

If these preventive measures could have been applied in 
China, 200 of the 300 children in this study who have died of 
these above-named diseases could have been saved. Though 
many of these preventive measures cannot be applied in China, 
much can be done. Three-fourths of the deaths of children in 
China are due to infectious diseases. This is the easiest class 
of disease to prevent. 

English statisticians'^ find that because of the reduction 
in death rates which took place in that country between the 
years 1871-80 and 1910-12, the English people have gained 
9,612,600 additional years of life. If lives of missionaries 
could be saved in the same ratio, probably the saving in years 
would be equivalent in the next three or four decades to a 
doubling of the missionary force. 

DYSENTERY 

This is the most widespread and destructive of the dis- 
eases attacking missionaries in China. In this study, 808 cases 
are recorded, with 84 deaths. For the total missionary body, 
at the same rate, the cases would number over 2,000, and the 
deaths over 200. The analysis of statistics concerning chil- 
dren shows that it is less sensitive than other infections to 
medical training on the part of parents, and deaths from dys- 
entery have not decreased in recent years as they have for 
other infectious diseases. Yet the disease comes only through 
the victim himself, or his nurse, putting the live germs into 
his mouth. Hundreds of thousands of dollars' worth of time 
and lives could be saved in a few years if missionaries knew 



Some Factors in Prevention of Disease 



101 



and applied the proper preventive measures. These measures 
imply the possession of kitchens which can be kept clean, and 
the means for properly sterilizing food and drink. 

TYPHOID FEVER 

If the death rate from typhoid for adults were known, it 
would be a much larger item than it is for children, since adults 
are more susceptible. Unlike dysentery, we have in preventive 
inoculation an invaluable weapon for fighting the disease. 

The morbidity from typhoid in the missionary army in 
China and in the United States-^ army is compared in Table 80. 



Table 80 



SICKNESS FROM TYPHOID FEVER AMONG MARRIED MISSION- 
ARIES AND UNITED STATES SOLDIERS 



Cases op Typhoid per 1,000 Years 
OP Service 



U. S. Anny, 1900-1908 (before compulsory inoculation) 
U. S. Army, 1912-1918 (after compulsory inoculation).. 
Married Missionaries (before 1919) _.- 



5.65 

.23 

7.69 



TYPHOID FEVER. 


CASES PER lOOO VEAft.3 oP 5ERV/CE 

^ 4 15 


n 


ADULT MI2JIONARIL£ 


1 




'880- 19l« 








U.S. A»MY (900- I9O0 
BEfORE COMPUtSOHY 
VACCIHAT/ON 


■ 






(i.S. ARMr ■ 1913 ■ 1918 
AFTCI'. COMPUiaORy 
VACCIWATIOM 



Figure 42. Sickness from typhoid fever among married missionaries 
and United States soldiers. (Illustrating Table 80.) 

Figure 42 shows how the rate has been lowered in the 
United States araiy following the compulsory use of typhoid 
— paratyphoid inoculations. 

If typhoid inoculation, together with reasonable care of 
food and drink, were used by all missionaries, the morbidity 
rate from typhoid could be reduced to the point reached by 
the army. In this event, using the values worked out by G. 
C. Whipple,^'' that each death from typhoid represents a loss 
of $6,000 {i.e., $4,634 for each person dying and $1,366 through 
disability for those cases that did not die), and assuming that 
during the next decade on the field the missionary force in 
China will average 7,500 adults, the amount of money saved 
to the societies in that time would be $336,000. If we consider 
the trained missionary worker of several times ' greater value 
than the average person of the United States is to his com- 
munity, this amount should be multiplied several times. 



102 The Health of Missionary Families in China 





pooooo 2oo ooo 3oo ooo 


SSTIMATCC SAVINO 




WITH UNIVERSAL 
JNOCULATION 










COST OF VACCINE 


BH 




B 


COST OF VACCINE, 
IN MISSION 
UABORATOR-V 



Figure 43. Amount of money which would be saved in ten years 

on the field with typhoid fever rate reduced to that of 

United States Army. 



The above figure is arrived at in the following way: 127 cases of typhoid 
are reported as occurring during the 17,600 years spent in China, or 7.69 
cases per 1,000 years. If the rate were reduced to .23, 7.46 cases per 1,000 
years would be saved. In 75,000 years this would amount to 560 cases. 
Among British missionaries2T in all fields it was found that 29% of the cases 
of typhoid resulted fatally. Suppose, however, that only 10% die, 5G lives 
would be saved. At $6,000 this would amount to $336,000. In this tabulation 
the estimated number of adults on the field is less than the number used in 
a previous article.25 

The cost of vaccine would be but a small fraction of the 
amount saved, and probably 90% of this in turn could be 
saved if vaccine were produced in the laboratories of a mis- 
sionary medical school and sent in bulk to all mission stations. 

Wide-awake missionaries and mission boards recognize 
the value of this method of insurance against typhoid. Yet a 
census of newly arrived missionaries in the Peking Union 
Language School in 1920 showed that 20% had been sent to 
China without this protection. 

A word of warning concerning inoculation is needed: 
"The triple typhoid inoculation confers a high degree of protection 
against typhoid and paratyphoid fevers, but it does not give absolute protec- 
tion against massive infection with the causitive organisms ... it does not 
warrant neglect of the other well-known sanitary precautions against the 
disease." (U. S. War Department— Regulations No. 28. March 11, 1919). 3i 

Among adults, 127 cases of typhoid fever developed in 
China, and 37 cases outside; 77% of the cases, therefore, oc- 
curred in China. The persons have spent an average of 11 
years in China, which is not more than a third of their life- 
time. The chances of the missionary getting typhoid has been, 
therefore, about 12 times as great in China as at home. 

SMALLPOX 

Most of the cases of typhoid fever occurred before 
typhoid inoculation had been introduced. All the cases of 
smallpox, on the other hand, occurred more than a hundred 
years after Jenner demonstrated to the world that, except 



Some Factors in Prevention of Disease 



103 



in rare instances, vaccination will protect from smallpox. In 
this study, 111 cases of smallpox, with 28 deaths, are reported 
among adults and children. For the whole missionary body in 
China this would mean a total of about 260 cases, with 55 
deaths. 



Table 81 MORTALITY FROM SMALLPOX AMONG MISSIONARY FAMILIES 

(ADULTS AND CHILDREN) AND AMONG GENERAL 
POPULATION IN ENGLAND AND THE UNITED STATES 



Number of Deaths prom Smallpox 



Per 100,000 inhabitants in England and Wales, 2' 1893-1902 
England and Wales, 1903-1917 

United States Registration Area, 1904-1908" 

Per 100,000 years Spent in Claina by Missionaries 



2.1 
.29 
.72 
68.5 



........ 


"" 


THi 


110 


> l,v„o(fOR. 
|20 


,JO 


^ 


rtr. 


too 000 
|4o 


VE*R3 


IN CHI 
ISO 


KA) 


,60 


HIiJIOWARY CHILD- 

REK AUD PARENTS 

1880 1918 


1 1 1 1 ' ' 1 


■ 

1 

1 










ma 












• 


QEHERAL POfULATlOK 


reos. I»i7 


UmTED STATES 
t5>OA tOOO 



Figure 44. Mortality from smallpox in missionary families and in England 
and the United States. (Illustrating Table 81.) 



Table 81 and Figure 44 show the relative mortality among 
missionaries' families in China and the general population of 
the United States and England for closely corresponding 
periods. 

It has been pointed out, already, that most of the loss 
from smallpox has been borne by three groups of societies. 

Among adults, 28 cases of smallpox are reported from 
China and 3 from outside; 90%, therefore, were contracted in 
China — during only one-third the life-time. The likelihood of 
the missionary getting smallpox has been about 30 times as 
great in China as at home. 

One missionary writes : *'0f 26 missionaries of one board 
who have come to this district, 12 have been attacked by 
smallpox." The high incidence of smallpox immediately 
raises an important question. How many of these cases were 
contracted in spite of the person having been vaccinated? 



104 The Health of Missionary Families in China 

To determine this point, the writer sent a question blank 
to 50 families, which had reported cases of smallpox. In an- 
swer, 30 families reported 51 cases of smallpox, 37 of which 
were not fatal and 14 fatal. The answers are summarized 
in Table 82 : 



Table 82 



CASES OF SMALLPOX, WITH REFERENCE TO PREVIOUS 
VACCINATIONS 



Number of 

Successful 

Vaccinations 


ATTACK FATAL 


ATTACK NOT FATAL 


Age at Attack 


Age at Attack 


0-1 
Year 


1-4 

Years 


5-19 
Years 


20 Plus 
Years 


0-1 
Year 


1-4 
Years 


5-19 
Years 


20 Plus 
Years 


Not 
Stated 


None. . 


8 

1 


1 






5 


2 
1 


11 
3 


2 
2 


3 
6 
3 

1 


3 


One 




Two _ 

Three 





Total 


9 


1 




5 


3 


14 


4 


13 


3 



Seventeen of the persons had been vaccinated, 35 had not 
been. In 12 of the 14 fatal cases vaccination had not been 
attempted. One other (a baby of eight months) had had an 
unsuccessful vaccination three months before. Out of the 14 
cases, there is record of only one case dying from smallpox 
after being successfully vaccinated. In this case (a seven- 
months-old baby) the vaccination had been done three weeks 
previously. Of these 14 fatal cass, eight were among, infants, 
and five among adults. 

Of the 37 cases which did not end in death, 21 had not 
been successfully vaccinated. Of the 21, in seven cases vacci- 
nation had been attempted, but had not ''taken." Sixteen 
cases had had successful "takes." Of these twelve had had 
one "take;" three, two "takes;" and one had had three 
"takes." 

In these cases it is important to know how long a time 
had elapsed between vaccination and contraction of the dis- 
ease. In those who had had one "take," the interval was in 
one case only a few days (a child exposed when the mother 
developed smallpox). In three cases the interval was a year; 
in one case, four years ; three cases, between five and fifteen 
years, and in four cases, more than fifteen years. 

Of the three cases which had had two "takes," the inter- 
val in one case was one year, and in two cases, ten to fourteen 
years. Only one case developed after three "takes." Here 
the last "take" was but a few days before. (Vaccination 
done just before the disease breaks out will not protect.) 



Some Factors in Prevention of Disease 105 

Eight cases of smallpox occurred less than five years 
after vaccination. Two of these were only a few days after, 
so that immunity had not had time to become established. 

One would expect the six other cases to be protected. 
Three of these cases were in one family. Vaccination had been 
done fifteen months before, and all three had large scars to 
show for it. Of 17 cases, then, which followed successful vac- 
cination, six were within a period in which the individual 
should have been immune. 

The information collected, though meagre, serves to em- 
phasize the importance of vaccination. Every death, with the 
exception of one, came in unvaccinated persons. The non- 
fatal cases which occurred in vaccinated individuals would 
indicate that vaccinations should be repeated at shorter inter- 
vals in China than in countries where smallpox has been 
almost eradicated. 

Several of the reports blamed the vaccine used for unto- 
ward results — eczema, epilepsy, even smallpox itself. Though 
the vaccine was not to blame, arrangements should be made 
so that the missionary body may be sure of a pure, fresh 
supply. 

Eight cases developed smallpox after failure to get a 
"take." In one case — a baby — the attempt had been made 
three times, the last one but three months before the attack. 
This points to the need of repeated attempts at vaccination. 
The writer knows of a successful vaccination of a baby after 
fourteen unsuccessful attempts. 

It is of interest to look at larger figures on this subject collected in the 
United States. Among 134,669 vaccinated persons exposed to smallpox, 619, 
or .46%, contracted the disease, of whom 13, or 4.2%, died. Among 147,941 
unvaccinated and exposed persons, on the other hand, 4,056, or 2.7%, became 
sick, of whom 282, or 12.6%, died. That is, the sickness rate among unvac- 
cinated is six times what it is in the vaccinated, and the death rate three 
times as great, or the chances of dying of smallpox are 18 in the unvacci- 
nated to 1 in the vaccinated. •''^ in another investigation in New York 
City"-! of 534 vaccinated persons who were exposed to smallpox, none became 
sick, while of 7,567 unvaccinated persons, 161, or 2%, contracted smallpox. 

These three diseases have been mentioned because they 
are most destructive (dysentery), or have a specific means of 
prevention (smallpox and typhoid). The evidence concerning 
other diseases (e.g., malaria, scarlet fever, diphtheria) might 
be analyzed with profit. 

CAUSES OF INFECTION 

Correspondents were asked to state, whenever possible, 
the cause of the sicknesses. A great variety of factors were 



106 The Health of Missionary Families in China 

named. Lack of medical attention was mentioned 37 times, 
usually in cases which resulted fatally. Inexperienced med- 
ical attention was blamed five times. Contaminated food, 
milk, water, unscreened houses, ignorant servants, boat travel 
(9 cases of dysentery, with 2 deaths, among 18 passengers on 
one trip of a Yangtse river boat), privation, poor houses, flies, 
over-medication, epidemics among Chinese, etc., were named 
from one to many times. 

METHODS OF DISEASE PREVENTION 

One hundred and eighty-six of those who filled out the 
questionnaire (about 14%) gave advice on the subject of main- 
tenance of health. The various points named are listed in the 
following table. The figures refer to the number of corre- 
spondents who mentioned the subject. 

Table 83 ADVICE CONCERNING HEALTH GIVEN BY 

MISSIONARIES 

Relating to Mission Boards: 

Institute comprehensive health survey 1 

Provide thorough physical examination of candidates 1 

Provide medical examiners conversant with conditions on the field. 1 

Provide medical instruction to candidates 1 

Provide information concerning conditions on the field 1 

Provide more medical attention on the field 1 

Provide professional and nursing care for women at childbirth. ... 2 

Have a rule that women be on the field for a year before marriage 1 

Increase the salaries 2 

Have a shorter time between furloughs 2 

Build better residences 1 

Provide houses at summer resorts 1 

Supervise the schools for children 1 

Relating to Stations: 

Display real Christian spirit 1 

In assignments, consider compatibility of dispositions 1 

Each family should board separately 1 

Relating to Housing: 

Arrange in large compound 2 

Have modern-style houses 6 

Have Chinese-style houses 1 

Sanitary plumbing, etc 4 

Proper screening 26 

At a distance from the street 3 

Drain neighboring pools 2 

Have self-closing servants' closet 1 

Have separate kitchen for servants 1 

Relating to Missionary Doctors and Nurses: 

Give more careful attention to foreign patients 3 

Advise early smallpox vaccination 4 

Warn community of sickness 1 

Give better prenatal care to missionary wives 1 

Examine wives after illness 1 

Maintain stricter quarantine 1 

Give furlough for sickness before death is imminent 1 



Some Factors in Prevention of Disease 107 

Relating to Yacations and Travel: 

Go to summer resort 22 

Don't go to summer resort 2 

Avoid summer travel 1 

Take extra care in traveling 2 

Don't travel third class 1 

Be careful of food on river steamers 2 

Relating to the Family — General Points: 

Study elements of medicine before coming 8 

Don't worry 1 

Get to feeling at home 2 

Maintain a confident attitude 2 

Acquire common sense 1 

Keep regular hours 1 

Daily exercise and recreation 13 

Daily bath 1 

Go to bed with clean mouth 1 

Expectorate after bad smells 1 

Don't worry about germs 3 

In sickness, trust the Lord 2 

Live as the Chinese do 1 

A little private income important 1 

Rest after tiffin 1 

Take life easy at first 1 

Listen to advice of older missionaries 1 

Older missionaries should advise 1 

Have a family game before bed-time 1 

Have proper bowel habits J 

Have comfortable beds 1 

Carry mosquito essence 1 

Control flies 2 

Have regular medical examination 1 

Take typhoid and paratyphoid vaccination 2 

In cold weather wear nightcaps 1 

Relating to Parents: 

Avoid children too often 4 

Have a small family 1 

Avoid early child-bearing on the field 3 

Learn duty of refusing to do good at family expense 1 

Relating to the Mother: 

No language study during pregnancy 1 

Learn the language 1 

Get "Holt" 1 

Exercise extra care during pregnancy 8 

Avoid cart travel when pregnant 3 

Stay in bed a month following childbirth 1 

Give less time to mission work and more to children 1 

Relating to Housekeeping: 

Learn how to cook 1 

Be a good housekeeper 4 

Personally supervise the kitchen 4 

Provide more proteids in diet 2 

Provide more fats 1 

Eat fresh bread ( to avoid sprue) 1 

Scald and then bake bread bought on the street 1 

Scald fruit 1 

Use only boiled water 24 

Use only boiled milk 12 

Use only cooked vegetables 4 



108 Th e Health of Missionary Families in China 

Relating to the Care of Children: 

Personal supervision of children by the mother 2ti 

Personally prepare babies' food 5 

Personally feed children 5 

Use care in preparing food 1 

Serve plain food 5 

Cow's milk important 3 

Keep your own cow 1 

Use goat's milk 1 

See that the milk is not watered 3 

Use tinned milk 1 

Use wet nurse if mother's milk fails 2 

Let children eat only at table 4 

Don't allow them to eat servants' food 1 

Don't allow them to eat Chinese food 3 

Don't allow them to eat Chinese candy 1 

Serve only cooked foods 1 

Serve plenty of fruits 2 

Send children home between 5 and 10 years 4 

Send children home between 10 and 15 years 2 

Send children home between 15 and 20 years 2 

Keep children's fingers out of the mouth 2 

Boil bath water 1 

Have daily mouth gargling 1 

Relating to Children's Bleep and Play: 

Follow usual normal life 4 

Provide exercise 2 

Lead outdoor life •• 

Don't let the baby creep on the floor 2 

Don't allow children to play in pools 1 

Guard against loneliness (in isolated stations) 1 

Put to bed by mother (to prevent bad habits) 1 

Put to bed early 1 

Provide mosquito nettings 4 

Open windows 3 

Sleep outdoors ? 

Use mosquito lamp i 

Keep inside after sundown in winter 1 

Relating to Clothing: 

Dress warmly in winter 2 

Wear cholera belt 3 

Protect from sun 5 

Use sun hats 4 

Provide stout shoes 1 

Don't allow the children to go barefooted on ground 1 

Relating to Medical Attention: 

"Watch stools 1 

Demand daily bowel movement 2 

Provide glasses if necessary 2 

Give periodic quinine 2 

Don't give too much quinine 1 

Give periodic santonine 1 

Have semi-annual examination for worm eggs 1 

Use prompt dieting on diarrhoea 1 

Have circumcised 1 

Early smallpox vaccination 1 

Relating to Relations with Chinese: 

Keep from Chinese visitors 1 

Keep from Chinese children 2 

Allow to play with Chinese children 1 



Some Factors in Prevention of Disease 109 

Servants — 

The fewer the safer 1 

Instruct servants 6 

Watch servants 2 

Keep children from servants ;; 

Keep children from other people's servants 1 

Have servants examined by doctor 1 

Watch for tuberculosis 4 

Watch for dysentery ] 

Watch for malaria 1 

Watch for syphilis 1 

Watch for trachoma 2 

Relating to Amah: 

Have none 3 

Select with care 1 

Don't change often ] 

Require to bathe regularly 1 

Provide with clean garments 1 

Watch for teaching immoral practices 1 

Relating to Schools: 

They are not properly heated -. 2 

Exercise and play neglected ] 

Children from south should go north 1 

Health in China and at Home: 
Chance for health in China — 

Better than in homeland 3 

As good as in homeland (if certain precautions are taken) 29 

Worse than in homeland 18 

Many of the collaborators in this study wrote feelingly on certain phases 
of this subject. There is not space to reproduce these letters, but some of the 
more striking sentences are set down. 

"Health of children not so good in China? Rubbish." 
"Some missionaries would be happier if they knew more about the 
interior of China and less about the interior of themselves." 

" 'Trust in the Lord and do good — so shalt thou dwell in the land.' " 
" 'Take cheerfully the spoiling of your goods.' " 
"Don't let your people send you funeral orations by every mail." 
"The excessive care necessary makes the children selfish and self- 
absorbed." 

"During the nursing months I live more nearly the life expected of a 
good cow." 

"A properly trained, trustworthy, Christian amah is better than a 
mother." 

"I (reared in China) know that some missionary children are allowed 
to learn vileness from bad servants. No mother ought to be so absorbed in 
the souls of the Chinese that she lets the devil get the bodies of her children." 

"Health is largely up to the housekeeper." 

"It ought to be language first then babies, or babies first then language, 
but certainly not both at the same time." 

"Don't let young missionaries presume on God's almightiness to nullify 
rashness." 

"The worm (round) that dieth not." 

"Our doctors pay no attention to prenatal examinations." 

"At home, the people who have the best doctors money can engage do 

not get the good attention I have had on the field, because these best doctors 

are so busy." 



110 The Health of Missionary Families in China 

"Microscopes are time consumers, but life preservers." 

"Have a physical examination once a year by a physician that will do 
a good job of it and take some time to it." 

"Get a 'fool-proof closet stool cover; keep the place whitewashed and 
clean-looking, so they (the servants) will be proud of it. Put a self-closing 
screen door on it in summer and hang a fly-swatter in it and encourage 
its use." 

"In one sample of cow's milk there was 75% of water." 

"Wanted, a 'Holt,' adapted for feeding in China." 

"Put play Into your schedule as religiously as you put work or Bible 
study." 

(From a physician) : "I would keep every pregnant and every nursing 
woman from language study. No one will believe in the necessity of such 
regulations unless she first transgresses them, and then the fat is in the fire." 

"One cannot expect the children of mothers to be well when the mothers 
. . . permit the ignorant and dirty Chinese to feed and care for the chil- 
dren's wants." 

(From a physician) : "When children do get sick they get much 
Inferior care, on the whole, than they would get at home. Everybody is so 
busy making statistics that foreign patients do not count. All appear to be 
affected with the Bacillo coccus statistinitis. Quantity instead of quality is 
the watchword." 

THE RESPONSIBLE AGENCIES 

Considering all the difficult circumstances of the past, 
missionaries and mission boards have doubtless done the best 
possible for the health of the workers. Mortality rates are 
doubtless pigmy sized in comparison with the huge physical 
difiBculties faced. However, in the light of important new 
medical knowledge, in the light of the present tremendous 
urgency for the missionary program, in the light of freshly 
opened reservoirs of funds, in the light of growing unity 
among Christian forces, — the health record for the past will 
not do for the future. The problem of the health of the work- 
ers needs to be handled in a new and bigger way. 

The purpose of this study is to set forth the facts con- 
cerning the health of a certain portion of the missionary force 
in China. It does not aim to present a detailed health pro- 
gram. That can be done only by the mission boards. 

This study would be incomplete, however, if the agencies 
concerned in the safeguarding of health were not indicated. 

1. The Individual Missionary. Most of the 161 items of 
Table 83 are concerned with the precautions which the indi- 
vidual should follow. In a country where one must be his own 
board of health such individual measures are most essential. 

2. Missionary Doctors. Doctors are supposed to bear the 
same relation to the missionary body that the medical corps 
of the army bears to the force in the field, but they cannot 
fully live up to that relationship without either large rein- 
forcements, or a decrease in their work for the Chinese. 



Some Factors in Prevention of Disease 111 

3. Groups on the Field. United efforts by mission sta- 
tions, the China Medical Missionary Association, union lan- 
guage schools, and other union organizations can assist 
greatly in making health measures effective. An encouraging 
feature is the coming of the China Medical Board. With the 
opening of the Peking Union Medical College hospital, mis- 
sionaries in China have at their disposal the advice of special- 
ists who are supplied with all the up-to-date equipment for 
the diagnosis and treatment of disease, 

4. The Individual Missionary Boards. In such matters 
as the securing and dissemination of accurate information 
concerning sickness on the field, the best methods of disease 
prevention, in the matter of salaries, housing, period of serv- 
ice, schools for children, etc., the responsibility rests not with 
the missionaries, but with the boards for which they work. 

The China Medical Missionary Association at its last con- 
ference held at Peking, in February, 1920, after considering 
some of the facts of this study, unanimously passed the follow- 
ing resolutions : 

Whereas, the health of the individual missionary and his family is 
essential to the success of the missionary enterprise, and, 

Whereas, the war has demonstrated the possibility of greatly reducing 
disease among the forces in the field through the use of modern methods of 
prevention and cure; and. 

Whereas, preventable sickness and death constitutes a continuing drain 
on the Christian forces in China; therefore, 

Resolved, that the China Medical Missionary Association should and 
hereby does call the attention of the missionary boards doing work in China 
to the need of an energetic, comprehensive, co-operative program, looking 
toward the physical well-being of the workers in the field. Among other 
items, such a program should include: 

"First, the tabulation by the boards of their health statistics for the 
past, and where the records are inadequate, the installation of a system 
of vital bookkeeping by means of which they and the doctors on the field may 
be in possession of the basic facts necessary for intelligent action. 

"Second, a thorough physical examination of candidates, with a greater 
degree of co-operation between examining physicians at home and physicians 
on the field. 

"Third, the more complete instruction of missionaries in the best means 
of guarding against disease in the section of the country in which they are 
to work. 

"Fourth, the securing for the missionaries of all the up-to-date means 
for the prevention of disease, such as yearly physical examinations, regular 
vaccination against typhoid, paratyphoid, and smallpox, proper housing, 
screening, etc." 

The China Medical Missionary Association especially offers its support 
In the planning and in the execution of any such forward looking program, 
and it hereby directs its executive committee to lay this matter before the 
missionary boards doing work in China, and to act with the boards in any 
measures which they may adopt. 



112 The Health of Missionary Families in China 

It should be pointed out that some of the boards have 
had already in force policies which cover most or all of the 
points enumerated in the foregoing resolutions. 

As an example, the plans of the Methodist Episcopal, North, board may be 
mentioned. In this board there is a medical department headed by a returned 
medical missionary, Dr. J. G. Vaughan. The health policy of the board 
includes, besides other lesser items, the following: A thorough physical exam- 
ination of candidates made by certain, well-trained, well-paid examiners in 
various centers in the country; examination blanks made in quadruplicate 
and a copy sent to the physician on the field; a health efficiency study based 
on health reports received trimesterly from each missionary on the field; a 
card index with complete health record of each missionary; the issuance of 
Life Extension Institute Bulletins; typhoid inoculations every two years; 
and supervision of activities of missionaries on furlough with special refer- 
ence to the requirements of health. This policy was adopted two years ago. 

The policy also recognizes the importance of co-operation between 
boards in such common problems as proper examinations, health surveys, 
etc., but unfortunately little in this line has been accomplished. The writer 
understands that in this respect British societies are considerably ahead of 
American societies. 

The Young Men's and Women's Christian Associations, though they 
have no practicing physicians on the field, are particularly careful concerning 
examinations, requiring yearly physical examinations on the field and such 
a thorough overhauling as is given at the Mayo Clinic when on furlough. 

Certain other boards take a lively interest in the health of 
their workers. Yet, considering China as a whole, as this study 
does, it is evident that many of the boards are far too 
lax. In order to gain an idea of the thoroughness of the atten- 
tion paid to the physical life of the successful candidate, a 
brief questionnaire was circulated in January, 1920, among 
the students of the North China Union Language School. 

Sixty-eight adults, all but two of whom had come to China 
within a year, filled out the question blank. Fifteen mission 
boards were represented. Of these 68, 30% had been exam- 
ined by doctors of their own selection, 23% had been given 
no advice concerning the maintenance of health on the field, 
20% had not been inoculated against typhoid fever, 6% had 
not been vaccinated (none of these were protected by recent 
vaccination), 9% had not had their urine examined. All but 
one had had a chest examination. Most of the neglected cases 
belonged to a certain few of the boards. 

5. Co-operation Behveen Boards. There are certain 
measures which individual boards cannot put into operation, 
at least not without wasteful duplication of effort and expense. 
The most important word in the C. M. M. A. resolutions is 
"co-operative." Not only at home (in ways suggested in 
the above-mentioned policy), but also on the field, more 
active co-operation is possible. For example, this study shows 



Some Factors in Prevention of Disease 113 

the overshadowing importance, even in the families of the 
medically trained, of the intestinal infections, dysentery, 
diarrhoea, cholera, etc. For the prevention of these diseases 
better sanitation is essential. But the sanitation of mission 
stations and Chijiese cities cannot be directed from New 
York, London, Stockliolm, and Copenhagen. Missionary doc- 
tors have neither the time nor the special training for this. 

There is needed a staff of health officers and sanitary 
engineers on the field, working under some union body such 
as the Joint Council on Public Health or the China Continu- 
ation Committee, Such a staff could compile vital statis- 
tics for the whole missionary body, advise stations and sum- 
mer resorts concerning sanitation, provide vaccines, conduct 
researches into the problems of health and promote public 
health measures among the Chinese in the cities in which mis- 
sionaries reside. 

As an instance of a minor problem in which missionaries can be helped, 
the following example is mentioned: 

At the Peking Union Medical College, under the leadership of Dr. J. H. 
Korns, 400 servants in the families of missionaries and other foreigners have 
been examined for chronic communicable diseases. Eleven per cent were 
found to have a positive blood test for syphilis, 11% had trachoma, 48% 
round worms, 1.8% hook worms, 1.7% were meningitis carriers, and 1.2% 
diphtheria carriers. Through treatment of servants who are diseased, through 
lantern lectures on home sanitation, as well as through the emphasis placed 
on good health, it is felt that the danger of infection from household servants 
in Peking is considerably lessened. For those employers whose servants 
have been found free of infectious disease, one cause of worry is removed. 

Because of the necessity of using boiled vegetables and 
milk, and expensive butter, the supplying of the growing child 
with a properly balanced diet, containing necessary food ele- 
ments, is a problem. (121 cases of difficult feeding and mal- 
nutrition and 13 cases of rickets were reported, but no case 
of scurvy.) Wilson,"*" and Adolph and Kiang" are studying 
the nutritive value of Chinese foods. Taylor"*^ has presented 
work on the feeding of the foreign baby. Mills^® has pointed 
out the value of chloride of lime for the sterilization of water 
in country traveling. Van Buskirk**^ has made a thorough 
study of the climate of Korea with reference to its effect on 
foreigners. The practical applications of these studies," and 
many others which should be undertaken, should be placed in 
the hands of all missionaries, either directly or through a 
column in the Chinese Recorder, 

For large undertakings, such as the building of schools, 
the institution of more complete sanitary measures in cities 
and at so-called health resorts (which are often the play- 
ground for epidemics), for effective protest to operators of 



114 Th e Health of Missionary Families in China 

river steamers, etc., there should be active co-operation be- 
tween the missionary body and the rapidly growing group of 
non-missionary foreigners doing business in China. 

THE EXTRAVAGANCE OF SICKNESS 

Back of mission boards lies the contributing, church, a 
church which seems sometimes to give best when its mission- 
aries are represented as suffering most of physical privation 
and hardship. In order that the boards may not be hampered 
in adopting "energetic, co-operative, comprehensive" health 
policies, there is need for an increased interest of the church 
in the physical welfare of missionaries and a realization of 
the fact that maintenance of good health is good economy. 
For this reason the facts of this study are not kept secret. 
Sickness anywhere is expensive, but w^lien the sick one or his 
successor has to be sent 10,000 miles, it is an extravagance. 
Things that make for health are not luxuries, but money- 
saving necessities. 

Modem preventive medicine has shown that, to a large 
extent, good health is purchasable. Pittsburgh,^" for example, 
has bought more than 300 lives a year (formerly taken by 
typhoid fever) by the erection of a $5,700,000 water filter 
plant, and considers the purchase a bargain. No man of busi- 
ness would spend several thousand dollars for an automobile 
and then let it go to the junk pile for lack of oil or for neglect 
of necessary repairs. Neither would the contributor to mis- 
sions, if the matter were presented to him, after spending a 
like amount for sending a family to the field, object to the 
additional expenditures necessary to keep it in health. Vac- 
cine, wire screening, proper medical advice, sanitary dwell- 
ings, adequate salaries, vacations, health surveys, etc., are ex- 
pensive, but not so expensive as sickness. 

It has been figured by a leading statistician that the periodic exami- 
nation of any group will save at least three lives per thousand per annum, 
apart from the dividends in increased health. If this is true, 20 lives a 
year would be saved to the missionary force in China through this one 
means. At the usual valuation of life, this would save at least $100,000 
a year. Since some of the boards already provide for regular examinations 
(usually only at the time of furlough) a yearly examination would not reduce 
mortality to the extent named. However, it should save $40,00n-$50,000, 
which would more than pay the expenses of a dozen additional doctors to 
conduct the examinations. 

The purchase of health, like any commodity of value, 
requires careful planning and the aid of expert advice. The 
employment of a staff of experts such as has been suggested, 
would, in the course of a few years, save hundreds of thou- 
sands of dollars now wasted in poor health and death. 



Some Factors in Prevention of Disease 115 

Such intelligent, scientific supervision of health would 
increase morale and make it easier to secure recruits among 
those who hesitate to expose children to the hazards of mis- 
sionary life. A missionary is not afraid of death, but he 
would rather be killed in battle, than tamely fall a victim of 
some easily preventable sickness. 



SUMMARY 

This is a study of facts concerning the health of 60% of 
the missionary families in China. Facts are tabulated con- 
cerning 1,300 marriages, and 4,831 persons (1,577 adults and 
3,254 children). Facts concerning 451 deaths of children, 59 
stillbirths and 416 miscarriages and nearly 7,500 cases of sick- 
ness are analyzed. The study represents a total of more than 
35,000 years spent in China. The principal facts which have 
come to light are as follows : 

1. Each marriage has resulted in an average of 2.5 chil- 
dren, which is at least 20% more than that for the average 
college graduate or college teacher in the United States. Only 
13% of the marriages are childless, against 31% among Amer- 
ican college women. 

2. American societies average 2.33 children per marriage, 
English and Canadian, 2.63 ; European, 2.88. 

3. Three-fourths of the families have no children dead. 

4. The children average SV2 years in age, 67% of their 
time has been spent in China. Ten per cent less time has been 
spent in Southern than in other provinces. 

5. Mortality amog these children is considerably less than 
half what it is among Chinese children, but IV2 times greater 
than among children of missionaries in Japan. (139 in China 
to 95 in Japan.) The excess for China occurs in the group 
of children aged 1 to 5 years. 

6. Infant mortality is only 60. The rate for the first six 
months is extremely low, lower than among professional men 
in England, but during the last six months it is two to three 
times as high, due largely to dysentery and other intestinal 
infections, which are, in turn, probably due to lack of breast 
feeding. 

7. Death rates of children from the second to the fifth 
years are three times as high as in countiy districts in Eng- 
land having about the same infant death rate. 



116 The Health of Missionary Families in China 

8. Mortality, in general, decreases from north to south. 
It is more than twice as high in North China as in South 
China. This is due both to the greater prevalence of the infec- 
tious diseases, and to the larger percentage of deaths among 
those taken sick. Intestinal and respiratoiy infections and 
smallpox are most markedly deadly in the north. Consider- 
ing the societies individually, most of them show higher mor- 
tality rates in the north than in the south. 

9. Mortality varies markedly in the various societies, the 
highest having three times the rate of the lowest. High rates 
are due to the general infections and intestinal diseases. Kates 
are higher in societies having the larger number of children 
per family. 

10. Mortality is higher in the societies reporting less than 
20 children. 

11. Mortality is equally low in American and English 
societies, the high rates found in European societies are due 
to dysentery, diarrhoea, and smallpox, each of which is two to 
four times as deadly as in American or English societies. 

12. Mortality is lowest when a parent is born in China, 
highest when parents are born in Europe. Of the latter class, 
15% of the deaths are due to smallpox. 

13. Mortality is lower in families where parents have had 
medical training, largely because of the decrease in general 
infectious diseases. Training of the mother is of more impor- 
tance than training of the father, as shown by decrease in in- 
testinal and general infections. This points to the advantage 
of education of the mother in home sanitation. 

14. Mortality is, in general, lower in societies having the 
larger ratio of doctors to missionary force. 

15. The decrease of mortality in the more recent years 
has probably not exceeded the rate of decrease in England 
and America. Infections other than dysentery have decreased 
most. 

16. Mortality has decreased for successive children 
through the fifth child, after which it has increased. Smallpox 
is six times as deadly among children bom sixth or later, 
while dysentery is less deadly. 

17. Large families have a considerabl}^ higher rate than 
small families. This is due to the general infectious diseases, 
including smallpox, and diarrhoea. This points to poor quar- 
antine within the home. 



Some Factors in Prevention of Disease 117 

18. Mortality rates are slightly lower for children born 
outside of China than for those born within. They are lower 
in the groups of societies in which parents have spent the 
largest percentage of time off the field. 

19. Dysentery has caused 19% of all deaths, diarrhoea 
12%, respiratory infections 13%, diphtheria 6%, conditions 
^^sociated with birth 10%, smallpox nearly 5%; 88% of 
deaths have occurred before the age of seven. 

20. Compared with the United States and England, dys- 
entery, smallpox and injury at birth take a large toll for the 
first five years. After five years, scarlet fever is relatively 
deadly. The early appearance of typhoid (7.5% of deaths 
from 5-9) points to the need of early inoculation. 

21. Less than 7% of deaths occurred in the homeland; 
33% of the time was spent there. 

22. Of the children dying aged five years or over in four 
groups of societies, one-third were killed in the late war. 

In general the various tabulations show that infant mor- 
tality is much less variable than mortality of childhood, also 
that rates due to birth, development and nutrition vary less 
than those due to infections. Since the diseases whose rates 
fluctuate most are most preventable, effort directed against 
the infectious (bacterial) diseases of early childhood will yield 
the largest returns. 

23. Sickness rates, in contrast with mortality rates, are 
highest in Central and South China, due to increase of malaria 
and intestinal parasites. In South China also, fewer children 
have robust health. Dysentery in relation to years of resi- 
dence is less prevalent in the coast and Yangtse valley pro- 
vinces. The absolute number of cases is greater in these sec- 
tions because the number of missionaries is greater. 

24. Scarlet fever, measles, mumps, chicken pox and 
whooping cough are contracted relatively more frequently 
outside of China than are the less highly infectious diseases. 

25. The largest number of dysentery infections occur dur- 
ing the second and third years, of diarrhoea during the first 
and second. The younger the child, the higher the mortality. 

26. Miscarriages number 13.4% of live births, the rate 
being highest in South China. The number of miscarriages 
per family is also highest in the south, 24% of the wives have 
had one miscarriage or more, a comparatively high rate. 87% 
of miscarriages occurred in China, against 82% of married 



118 The Health of Missionary Families in China 

years spent there. Travel and overwork caused a larger pro- 
portion of miscarriages at home than it did in China. Over- 
work, disability, nervousness, etc., are thought to be respon- 
sible for one-half of the miscarriages. 

27. Stillbirths were 1.84% of living births, a low rate, 
probably largely due to the absence of syphilis among mis- 
sionaries. 

28. Missionaries have been married an average of 11.6 
years. The average adult life on the field is 20% less in South 
China than in North China. 55% have been in China 10 years 
or less. 

29. Most numerous diseases among adults in China in 
order of frequency are : malaria, dysentery, typhoid, nervous 
breakdown, influenza, diarrhoea, spine, appendicitis opera- 
tions, smallpox, typhus fever, tuberculosis. Central and South 
China show larger numbers of illnesses than North China. 

30. Cases of malaria and dysentery are much more numer- 
ous among husbands than among wives. In the case of sprue, 
the reverse is true. 

31. Forty-six per cent of the infections are contracted 
within the first three years after arrival in China. 

32. More than half (53%) of adults have had serious 
illness in China. Fewer have been sick in North China than 
in Central and South China. The rate is the same for hus- 
bands and wives. 

33. Only 20% of wives and 30% of husbands say they 
have been in robust health. For wives, the proportion is con- 
stant for the sections of China. For husbands, 33% in the 
north have had robust health, against 17% in the south. This 
is perhaps due to the especially high incidence of malaria 
among husbands in the south. 

34. The proportion having robust health in various soci- 
eties varies widely, but in general, the societies with high mor- 
tality rate among children have a low percentage of robust 
health among parents. In general, though mortality among 
children is much higher in the north, the morbidity rate 
among adults and children is less, miscarriages fewer, the 
general health better, and the residence in China longer for 
those who live in North China. This is because the diseases 
of North China (dysentery, pneumonia, diphtheria, scarlet 
fever, smallpox) cause death. Those of South China (mala- 
ria, intestinal parasites) and the climate, cause invalidism. 



Some Factors in Prevention of Disease 119 

35. Three-fourths of the deaths of children are due to 
infectious diseases, for which the ratio of preventability is 
high. Given knowledge and command of preventive measures, 
it is possible to save 200 of the 300 deaths from the infectious 
diseases here recorded. 

36. Among adults and children here reported (about 41% 
of the total missionary body) dysentery has caused 808 cases 
of sickness and 84 deaths. 

37. If the typhoid fever rate were reduced to that prevail- 
ing in the United States army since the introduction of com- 
pulsory inoculation, in ten years on the field there would be 
a saving of 56 lives and $336,000. Typhoid contracted by 
adults in China outnumbers cases contracted by them at 
home 12 to 1. 

38. One hundred and eleven cases of smallpox, with 28 
deaths, are recorded among children and adults, a rate 95 
times that for the general population of the United States. 
No deaths have occurred in families in which parents have 
had medical training. In 51 cases in which the record of vac- 
cinations is known, six cases occurred in individuals who had 
''takes" within five years, pointing to the need of more fre- 
quent vaccination. Only one death occurred in a person who 
had been vaccinated. Cases of smallpox contracted by adults 
in China outnumber cases contracted at home 30 to 1. Among 
the children, no case contracted outside of China was reported. 

For some of these conclusions, modifying sojrces of 
error, which have been named, should be noted. A closer com- 
parison of facts will be possible when statistics now being col- 
lected among missionaries in Japan and church members in 
America have been tabulated. 

In certain sections of China, or among certain groups, 
children of missionaries have as good a chance for life and 
health as children at home. Taking the missionary body as 
a whole, however, there has been an excessive loss of life 
among both children and adults. Much of this loss may in 
future be prevented. For such prevention, both intelligent 
vigilance on the part of the individual and a larger co-opera- 
tive health program on the part of the churches is needed. 
Increased expenditure, if based on facts, would result in great 
money-saving, and would aid in bringing nearer the longed- 
for coming of the New Day to China. 



120 The Health of Missionary Families in China 



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